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PHYSICAL
DISABILITY-
PSYCHOLOGICAL
APPROACH
N
Under the Editorship of Gardner Murphy
PHYSICAL
DISABILITY-
A PSYCHOLOGICAL
APPROACH
Beatrice A. Wright
Department of Psychology
University of Kansas
HARPER & ROW, PUBLISHERS
New York and Evanston
PHYSICAL DISABILITY— A PSYCHOLOGICAL APPROACH
Copyright © 1960 by Beatrice A. Wright
Printed in the United States of America
All rights in this book are reserved. No part of the book
may be used or reproduced in any manner whatsoever
without written permission except in the case of brief
quotations embodied in critical articles and reviews. For
information address Harper & Row, Publishers, Incor-
porated, 49 East 33rd Street, New York 16, N. Y.
Library of Congress catalog card number: 60-5732
To My C.R.E.W.
Digitized by the Internet Archive
in 2011 with funding from
National Federation of the Blind (NFB)
http://www.archive.org/details/physicaldisabiliOObeat
Contents
Foreword xiil
Preface xvli
1. Circumscribing the Problem I
The Scope of Questions Considered
Terminological Issues
Dangers of Short Cuts
DisabiUty vs. Handicap
Physical Definitions and Psychological Understanding
2. Inferior Status Position 13
Comparison with Minority Groups
Underprivileged Status
Overlapping Situations
Group Stereotypes
Differences in Minority-Group Position
Manifestations of Lower-Status Position
"As If" Behavior
Idolizing Normal Standards
Group Identification
The Echpse of Behavior Possibilities
Compensation as Indemnity
Effects on Personality
Opinion and Research Findings
Oversimplified Connection Between Disability and
Inferiority Feelings
3. Salutary Status Position 57
Coping vs. Succumbing
Attractions and Aversions as Expressions of Coping-
Succumbing
Underlying Conditions
Implications for Rehabilitation and Education
Expectation Discrepancy
Conditions Underlying Expectation Discrepancy
'iii Contents
Reconciling the Expectation Discrepancy
Suffering and Understanding
Outstanding Success
Dilemma of Contradiction in Status
4. Frustration and Uncertainty 86
Frustration
Two Studies
Evaluating the First Common-Sense Notion
Evaluating the Second Common-Sense Notion
Uncertainty Arising from New Psychological Situations
5. Value Changes in Acceptance of Disability 106
What Kind of Acceptance?
Enlarging the Scope of Values
Conditions Underlying Mourning
Overcoming Mourning
Subordinating Physique
Containing Disability Effects
Spread
Pertinent Research Findings
Theoretical and Social Missteps
Comparative Values and Asset Values
Acceptance and Adjustment
6. Development of the Self-Concept 138
Differentiating the World and Integrating the Self
Integration and Self-Evaluation
A Two-Way Process
Two Gradients in the Spread from Single Attribute to
Self-Evaluation
Age of Occurrence of DisabiUty
Conclusions for Child-Rearing Practices
7. Self-Concept and the Perception of Interpersonal Relations 162
"Believing Is Seeing" — Illustrated
Interpretation of Social Relationships in the Framework
of Perception
The Role of Self-Concept in Expectations
Expectancy Strength
Expectations and Social Understanding
8. The Adolescent with a Physical Disability 179
Heightened Importance of Physique During Adolescence
Overlapping Situations in Adolescence
Contents ix
The Adolescent Peer Group
The Case of Russell Criddle: An Adolescent with a
Disability
9. Grievances and Gratifications in Everyday Relationships 208
The Problem of Curiosity and Discussion of the Disability
Conditions Underlying Evaluation
Management by the Recipient
Recommendations
The Problem of Help
Help as a Social Relationship
Help as an Expediting Act
Management by the Recipient
Recommendations
The Problem of Sympathy
Unwanted Sympathy
Nature of Potentially Acceptable Sympathy
The Problem of Social Participation
"Treat Me Like Anyone Else"
Inclusion Through Accommodation
The Problem of Ridicule and Taunting
Requirement of Mourning
Management by the Recipient
Recommendations
10. Sources of Attitudes Toward Persons with Atypical Physique 251
Reaction to Physical Deviancy Among Lower Animals
Atypical Physique in Primitive and Nonoccidental
Societies
Requiredness in Cause-Effect Relations
The Different and Strange
Childhood Experiences
Socioeconomic Factors
I i. Training in Social Skills 274
Role Playing
Real-Life Situations with a Person Who "Knows"
Real-Life Situations v^dth Other Novices
Bringing the Outside Inside
Sharing Life Experiences Through Group Discussion
Discussion of a Story
12. The Parent as a Key Participant 288
Qualitative Aspects of a Sound Relationship
Interfering Parental Attitudes
X Contents
Interfering Counselor Attitudes
Topics and Understandings Comprising a Broad
Rehabilitation Program
The Problem of Hope Versus Stark Reality
The Problem of Overprotection, Dependence, and
Independence
Overprotection Negative by Definition
Glorification of Independence
Specific Aids in Achieving the Dependence-
Independence Balance
Parental Attitudes Underlying Overprotection
13. Motivating Children in the Rehabilitation Program 318
Rehabilitation Exhibits
Wally, His Mother, and His Braces
A Physical Therapy Session with Ben
Lila Participates in the Speech Class
Questions Toward Improving Motivation
Can the Task Be Recast so That It Becomes Part of
an Activity That the Child Likes to Do Anyway?
Is the Child's Overall Experience in the Rehabilitation
Session One of Success or Failure?
Is There a Place for Extraneous Incentives?
What Else Is the Child Learning?
Are Background Factors (Time, Place, and Social
Conditions) Optimal for Learning?
What Are Some of the Basic Attitudes That the Child
Has Toward His Disability and the Rehabilitation
Procedures That Surround It?
Does the Motivator Feel Friendly to the Child and the
Task at Hand?
14. The Client as Comanager in His Rehabilitation 345
Basis for Encouraging Comanagement on the Part of the
Client
Client and Counselor as Part of Management Illustrated
Further Implications of the Principle of Comanagement
Terminology as a Problem of Communication
The Importance of Clarifying the Situation
Conditions for Withholding Information and Imposing
Decisions
Factors Hindering the Mutual Sharing of the Management
Role
Contents xi
15. An Assessment of the Field of Somatopsychology 364
The Heritage of Somatopsychology
Current Approaches Linking Physique and Personality
Overall Findings of Research in Somatopsychology
Inconsistencies in Results and Their Usefulness
General Results
Necessity for Considering the Underlying Factors
Bibliography 381
Index of Names 395
Index of Subjects 399
Foreword
Human physique has a central place in naive, common-sense psy-
chology. It is generally believed that a person's body influences his be-
havior by way of the many phenomenal properties it has for him and his
associates, and by way of its greater or lesser efficiency as the instrument
with which he attempts to carry out intended actions. Variations in physi-
cal size, beauty, and normality, for example, are widely presumed by
businessmen, artists, and athletes, by politicians, suitors, and doctors to
be important causal variables within the total context of factors which
determine behavior and personality. One common theory is expressed by
Shakespeare in Richard 111, where the crippled Richard, Duke of
Gloucester, says:
But I, that am not shaped for sportive tricks,
Nor made to court an amorous looking-glass;
I, that am rudely stamp'd and want love's majesty
To strut before a wanton ambling nymph;
I, that am curtail'd of this fair proportion,
Cheated of feature by dissembling nature,
Deform'd, unfinish'd, sent before my time
Into this breathing world, scarce half made up,
And that so lamely and unfashionable
That dogs bark at me as I halt by them;
. . . since I cannot prove a lover,
To entertain these fair well-spoken days,
I am determined to prove a villain
And hate the idle pleasures of these days.
Plots have I laid, ....
An opposed view is given by Robert Burton in his Anatomy of Melan-
choly:
Deformities and imperfections of our bodies, as lameness, crookedness, deaf-
ness, blindness, be they innate or accidental, torture many men: yet this may
comfort them that those imperfections of the body do not a whit blemish the
soul, or hinder the operations of it, but rather help and much increase it.
XIV
Foreword
Scientific psychology has not in the past been much concerned with
these kinds of relations between physique and behavior; it has emphasized
other body-mind interdependencies; for example, those between the brain
and behavior, emotions and ulcers, the cochlea and hearing, genes and
intelligence, and hormones and personality characteristics. When the
phenomenal and instrumental interconnections between the psyche and
the soma have been considered by psychologists, they have usually been
discussed in terms of rather unsystematic, recondite processes such as
body image, organ inferiority, and cathexis to disabled parts; or they
have been seen as mere technological problems for psychological prac-
titioners who deal with the education, employment, or counseling of
disabled persons.
Dr. Wright's book provides welcome evidence that a change is taking
place in psychology with respect to these matters, and that the phenomenal
and instrumental significance of physique is receiving a new and deserved
emphasis. Physical Disability — A Psychological Approach is much more
than a symptom of this change, however; it makes important contributions
to the new development by carefully collating available data and relevant
theories, by contributing new concepts and interpretations, and by integrat-
ing the whole problem within the context of persisting psychological issues.
Altogether, Dr. Wright makes an impressive case for considering somato-
psychology, as it has been called, a valid subdivision of the science of
psychology, with a unique syndrome of facts, theories, and investigatory
and therapeutic techniques. Every psychological theoretician would do
well to confront his system with the facts of life and of psychological
science to which Dr. Wright draws our attention.
As is proper in the early days of a new scientific development. Dr.
Wright has a place in her book for diverse viewpoints and facts. She is not
limited by a narrow theoretical partisanship. On the other hand, Physical
Disability — A Psychological Approach is not merely eclectic; an organized
conception of the somatopsychology of physique emerges.
Physical Disability — A Psychological Approach marks a milestone for
the professions that deal in practical ways with the behavior and adjust-
ment of physically deviant persons. It places the psychological side of
disablement within a framework of sound concepts, and in doing so
contributes in an important way to making rehabilitation psychology an
applied science rather than, as heretofore, a welfare specialty based
largely on experience and art. Her own extensive, practical experience
with these matters saves Dr. Wright from leaving reality behind and
soaring too soon into scientific outer space. The wealth of concrete ex-
amples she presents and her ability to deal with complicated issues without
using an unduly technical language will make the Physical Disability — A
Foreword xv
Psychological Approach of interest and value to a wide range of profes-
sional people.
Roger G. Barker
Professor of Psychology
University of Kansas
Pref
ace
Throughout recorded history, and probably before, man has been
intrigued by the possibility that the outward characteristics of physique
might in some way be a guide to the inner nature of man, to his tempera-
ment, his character, his personaHty. It is not difficult to understand how
such a deep-seated belief might become estabhshed.
In daily contacts there are many cues from physique, posture, clothing,
and other aspects of outward appearance that serve to give information
about a person's calling and habits. This identifying information readily
breeds the impression that one "knows" more about the individual's
personality than is actually the case. The philosophical tenet that holds
man to be an essential unity, that the mind and the body are different
aspects of the same individual, lends intellectual support to the belief in
the intimate interdependence of physique and personaUty. Scientific in-
vestigations of psychosomatic medicine provide many indications of the
effects of sustained emotional states upon the physical condition of man.
Inversely, there are instances in which obvious physical stigmata, such as
in cretinism, imply defects in mental functioning. Finally, it is only with
sophisticated restraint that one guards against the jump from the incon-
trovertible fact that physique is an important determiner of behavior to
the tempting conclusion that personality is manifested in physique.
There has been a sobering balance to the readiness to accept body-mind
connections uncritically, however. Most of the inferences about person-
ality based on physical signs have found no factual support in systematic
investigation. Where relationships are revealed, the correlations are typi-
cally low. Ideologically speaking, the belief in free will has led some to
look askance at physical constants that impose limitations on man's
nature. If features of the face, or deformities of the body, or meanderings
of body chemistry bespeak and determine personality, then man to some
extent becomes a pawn of impersonal forces. The democratic viewpoint
has also tended to find it more congenial to focus on environmental condi-
tions, especially those controllable by man, rather than on immutable
hereditary and physical factors under which man must bow. Particularly
in American democracy, which upholds the value of man's rugged indi-
xvili Preface
vidualism and prefers the notion that man's future is determined by his
own dogged will and ingenuity and not by coercive limitations on any
front, did the emphasis tend to become the one of choice. Deeper analysis,
of course, shows that there is no basic contradiction between these
ideological viewpoints and the search for body-mind interrelationships, for
the fact that man to some extent is influenced by impersonal factors does
not keep him from influencing the course of events as weU. He is as much
a determining organism as one that is determined.
The present volume is concerned with one segment of the relation
between man and his physique, namely, the somatopsychological problem
as seen in disablement. The emphasis is on the kinds of social-psychologi-
cal situations that confront a person with an atypical physique, and how
he copes with them. Factors within the person and factors attributable to
the environment are considered in terms of how they aid psychological
adjustment or, on the negative side, how they create difficulties.
Many topics of importance to the problem of adjustment to disability
do not appear within the pages of this volume, the reasons for exclusion
being varied. First of all there is the matter of author limitations. The
theoretical background and range of experience and competency naturally
tend to prescribe certain questions and exclude others. Foreign references,
unfortunately, are notable by their absence. Then there is the direction
indicated by available research and the considered thinking of others.
Moreover, the scope of a single book must perforce be limited, and the
outlines become dictated in part by the substance initially worked
through.
There is no doubt that to some extent the contents of this volume have
been shaped by preconceived notions, but it should also be noted that they
have been reshaped as the evidence of scientific investigation and con-
sidered opinion added to the perspective of the person as an active agent
in meeting the impositions of a disability. Since fiction far more than fact
characterizes many ideas about psychological aspects of disability, it is
well to embark upon the reading of this book with an eye critical of those
personal views that have long been cherished as well as of those that may
here be proposed in their place. Certainly not all the assertions made have
scientific validity. But it is hoped that many of them are supported by
sound psychological thinking and by research evidence where possible. In
any case all of them are advanced "until further notice."
I should like to say a few words about the personal documents as used
herein. Because most of them are taken from literary productions written
by the person himself, they sample predominantly the introspections of
persons who are highly verbal, thoughtful, and who have a solid comple-
ment of psychological resources as well. But the purpose of these docu-
ments is not to prove the theoretical position advanced — rather tha
Preface xix
purpose is to illuminate it. Through the documents a vividness h achieved,
a concreteness and exemplification of what might otherwise appear as too
abstract and theoretical for the reality of psychological man. It is for this
reason that the book was designed as a combination text and case book.
Those readers who have a good deal of familiarity with problems of dis-
ability will easily be able to skim over the case material, but for others it
illustrates the living situations in which the problems under discussion
occur. It is also believed that many of the psychological events portrayed
in the personal accounts are not unlike, in principle, those which touch the
lives of the more drab, plodding, and unimaginative. Insofar as psychologi-
cal principles are being expounded, the specification of causes and effects
allows exemplification through the pertinent life history. At the same time,
longitudinal records of the lives of persons among the less articulate and
less successful with different disabling conditions would be valuable as a
source of new insights as well as a check of old ones.
This volume was written for the practitioner in the field of rehabilita-
tion, especially for the professional in training, though I would like to
believe that the research worker will also find some leads for productive
exploration. Because "the practitioner" covers a wide range of professions
— medicine and nursing; occupational, physical, and speech therapy;
social work, psychology, and psychiatry, to mention a few — and because
in some instances the patient as well as his family may be interested in
the material, an attempt was made to avoid technical language com-
municable only to "the trade." That some readers will find particular
sections "too simple" or "too difficult" is foreseen, which situation can
be used to advantage if the individual reader will select for more careful
study those chapters that hold promise for him.
The recognition that one's own work is also in many ways the product
of those from whom one has learned leads me to think about my psycho-
logical lineage. K I had to single out a handful of my teachers and col-
leagues who had the greatest impact on my thinking as a psychologist, the
following would be high on the list: Solomon Asch, Roger Barker, Tamara
Dembo, Fritz Heider, Kurt Lewin, Carl Rogers, and Erik Wright. Their
mark is indelibly impressed in many of the ideas elaborated in this book
and would be detectable even if no mention had been made of them.
I wish to express my thankfulness to those who have read all or
parts of the manuscript: Roger Barker, Louise Barker, David Klein, June
Kounin, Gardner Murphy, Stephen Richardson, Phil Schoggen, Anthony
Smith, and Erik Wright. Their suggestions have led to wise clarification
in the treatment of several of the problems discussed. The editorial
acumen of David Klein was especially valuable in tightening the manu-
script and detecting obscurities. It is also a pleasure to mention with
gratitude the Association for the Aid of Crippled Children, who provided
XX Preface
a grant and editorial assistance in support of this undertaking and
patiently awaited its completion in spite of the vicissitudes that marked
its course.
To the publishers who gave permission to use the material quoted,
special thanks. The reference sources are generally indicated by author
and date, referring to items in the bibliography.
I feel a special bond of friendship and indebtedness to those whose
personal documents were used freely in the discussion. I only hope that
reference to the details of their lives and innermost feelings, most of them
from published sources, will be taken not as an intrusion into their
privacy but as a contribution to the understanding of social-psychological
factors important in adjustment to disability.
These remarks are strangely incomplete without the expression of my
deepest feelings to my family — my husband, children, and parents — who
did so much to make possible the completion of this book.
Beatrice A. Wright
November, 1959
PHYSICAL
DISABILITY-
PSYCHOLOGICAL
APPROACH
1
Chapter "
Circumscribing the Problem
At certain times and places, particular fields of investigation
enjoy wide interest and prestige. In psychology, for example, the study of
mental aberrations — the psychoses and severe neuroses — holds such a
position today, whereas the study of adjustment to physical disability is
only beginning to be regarded as a serious area of investigation by more
than a few isolated psychologists.
That the place of the psychology of disability is secure, however, is
guaranteed by several considerations of far-reaching importance. First of
all, psychological knowledge gained from diverse fields can fruitfully be
brought to bear on problems of physical disability, thereby reducing suf-
fering and disablement and facilitating adjustment. Many concepts and
findings "belonging" to the traditional areas of social psychology, percep-
tion psychology, and clinical and counseling psychology appear throughout
the topics treated in this book, the title of which might appropriately
have been General Psychology Applied to Disability Problems.
An equally exciting consideration is that direct study of the psycho-
logical aspects of disability is producing new knowledge that applies far
beyond its immediate context. Just as probing into mental illness produced
insights into many psychological phenomena that were later seen to be
relevant to the mentally normal, so the examination of problems asso-
ciated with physical iUness and disability forces attention to important
areas of general human behavior that otherwise tend to be neglected. The
matter of accepting the loss of something valuable (Chap. 5) is one such
area. The phenomena designated as the requirement of mourning (Chap.
9) are another. Problems arising from ordinary interrelationships, such as
helping, sympathizing, pitying, staring, and questioning (Chap. 9), consti-
tute a third. The idolizing of normal standards of behavior (Chap. 2) is
still another. Even the sophisticated psychologist, we believe, wUl find
several new signposts pointing toward the understanding of unexplored
and vital areas of human nature.
The psychological aspects of disability as an area of investigation are
also receiving higher priority with the recognition that most people are at
some time forced, either directly or indirectly, to meet the challenge of
I
2 Physical Disability — ^A Psychological Approach
disability. That the number of persons with physical disabilities is large is
seen from the following brief sample (National Health Education Com-
mittee, 1955):!
Deaf and hard of hearing 4,560,000
Orthopedic impairments 3,168,000
Epilepsy 1,500,000
Blind and partially sighted 600,000
Cerebral palsy 550,0002
If family members and friends are legitimately included among those
concerned, the number immediately affected becomes enormous. If we
further consider the fact that adjustment to disability is made easier by
wholesome preparation for this eventuality, especially when such prepara-
tion is facilitated by the attitudes and behavior of society, then no one is
excluded from having a vital stake in discoveries relating to psychological
aspects of disability.
With the recognition that the psychological aspects of disability may be
more handicapping than the physical aspects comes the realization that
a psychological look at disability problems is imperative. Actually, in view
of the democratic tenet that "all men are created equal," in the sense that
the dignity and worthiness of the individual stand above differences in
endowment, one does not have to seek additional justification for holding
that the area of physical disability must command scientific attention.
THE SCOPE OF QUESTIONS CONSIDERED
Our broad concern will be with the way in which the person with a
disability copes with its social and personal connotations, these being
aroused by the fact that the disability imposes certain limitations and is
felt as a loss or denial of something valuable. We shall explore some of
the social-psychological conditions that hamper adjustment and those
that facilitate constructive efforts. These matters are in the domain of
what has been called the somatopsychological relation, a relation dealing
with "those variations in physique that affect the psychological situation of
a person by influencing the effectiveness of his body as a tool for actions
or by serving as a stimulus to himself or others" (Barker et al., 1953:1).
This is to be distinguished from the psychosomatic relation: that is, the
1 Dates within parentheses refer to works listed in the bibliography, pp. 381-
394.
2 These figures are estimates for the U.S. based on information supplied by
voluntary health groups and government agencies. More precise data can be
expected from the continuing annual survey of the extent and nature of illness
and disability in the U.S. inaugurated by federal legislation in 1956.
circumscribing the Problem 3
relationship between the mental and emotional characteristics of a person
and his predisposition toward certain types of organic dysfunction. The
psychosomatic problem is conceptually distinct from the somatopsycho-
logical and is not discussed in this volume.^
The somatopsychological relationship involves social-psychological
factors: that is, conditions that depend upon the interaction between the
person and others. Much of the psychology of the individual is, in fact, a
social psychology, for the way in which one feels and behaves about many
things depends in greater or smaller measure upon one's relationship to
other persons. Problems that on first appraisal may seem to be purely
personal often reveal, on more careful scrutiny, a social basis. Consider
the person whose disability permits him to accomplish the basic routines
of living, such as dressing or eating, only with great effort. One might feel
that the difficulty resulting from the wide gap between his abilities and
the task requirements has nothing to do with the social environment. Yet,
when we recognize that some — and often an important part — of his dif-
ficulty stems from his expectations that he must eat in a certain way and
wear certain clothes, ways of behaving prescribed by society, we realize
that understanding the individual requires social-psychological understand-
ing.
We are sure that there are far fewer psychological experiences peculiar
to persons with physical disabilities than an offhand guess might indicate.
Even in the case of sensory loss, as in blindness or deafness, the psycho-
logical significance of the deprivation has to do in large measure with
such matters as the threat of social isolation, the struggle for independ-
ence, acceptance of a personal limitation, and so on — experiences with
which many, if not aU, human beings are conversant. Throughout this
volume an effort is made to point out the generality of the concepts used
as well as to apply generally used concepts to the disability-connected
problem under discussion.
At the same time, certain kinds of psychological situations appear with
such intensity in the lives of many persons with disabihties that these
persons are forced to cope with them directly and to come to terms with
themselves as human beings. The following scenes sample some of the
great dramatic episodes experienced in principle by large segments of
humanity, including the nondisabled, and, in their concrete manifestations,
by many persons with disabilities.
Louise, a young woman who suffered the loss of one leg in childhood
and is now on crutches, encounters prejudice in looking for a job:
3 For a systematic statement differentiating several types of connection
between a person and his disability see Barker et al. (7955:1-8). For an overall
account of the psychosomatic problem and evidence bearing upon it, see Weiss
and English (1943), Wittkower and Cleghom {1954), and Dunbar {1954).
4 Physical Disability — A Psychological Approach
[I had] a letter in my purse which introduced me, with some flattering
phrases, to the field secretary of a large national girls' organization. ... I had
operated for four summers on the Pacific Coast as a counselor in the camps of
this organization. According to the Los Angeles executive, my work was highly
satisfactory. She had used me in various capacities — camp craft, handcraft,
swimming, hiking, etc. The children liked me and I had no discipUne prob-
lems. . . .
In fact, the Los Angeles executive was sufficiently impressed to express the
opinion that I had something of a talent for leading the young. She encouraged
me to consider seriously the possibility of a career in her organization. With
this in mind, she equipped me with the introduction and suggested that I . . .
discuss the matter with the national executive. . . .
I was completely unprepared for the blasting brushoflf I got. . . .
She [the field secretary] told me that with my horrible handicap I should
never for a moment consider an active job that involved leadership of young
people or contact with the public. Her implication was not only that I was
halt, but that the very sight of me would warp a sensitive young mind.
In frantic haste to justify my mad entertainment of such ridiculous heresy, I
tried to tell her how fast I could swim, how far I could hike, and all about my
four summers in camp and the serenely happy and uncomplicated reactions of
all the children I had shepherded.
I didn't talk very well because there was a sob suffocating its lonely self in
my tight throat. I finally left and walked twenty-two blocks to my hotel rather
than get in a taxi and let the driver see me cry [Baker, 1946:12S-131]^
Russell Criddle, an adolescent with sufficiently poor vision to be classi-
fied as blind, rejects pity and suffers the anguish of not being wanted as
a dating partner:
I was further disturbed when I sensed that others were pitying me for my
loneliness. I learned to pretend that I was not lonely, just as I pretended that
I could see, but this pretense was far more difficult. A subtle advance, and a
subtle rejection, one girl telling another, and it soon became general knowledge
that I was an unwanted person. Had a girl felt attracted toward me it would
have been humiliating indeed for her to have accepted me after ninety per cent
of her associates had turned me down. I sensed all this, even then, and was
ever alert for new girls, new faces, new circles of friends.
One night Bud arranged a party date for me with a cousin who was visiting
his family. Bud neglected to tell her about my eyes, and she did not discover
my handicap until the evening was well advanced. She had seemed to hke me,
and I had sensed her acceptance of me. But when she found me out she was so
distraught that she left alone, without even waiting for the cake and ice cream
[Criddle, 1953:54-55].^
* Reprinted by permission from Out on a Limb by Louise Baker, published
by McGraw-Hill Book Company, Copyright 1946 by Louise Baker.
* Reprinted from Love Is Not Blind by Russell Criddle by permission of
W. W. Norton & Company, Inc. Copyright ' 953 by Russell Criddle.
Circumscribing the Problem 5
Wally, a 4-year-old boy seriously crippled from poliomyelitis, is angered
and frustrated as he struggles to get his coaster wagon up a low incline
between the road and sidewalk, a situation that would have been easily
mastered by a nondisabled child:
9:44 a.m. Using the wagon as a prop and holding onto it with both hands,
he pulled himself up off the ground from a sitting position. He put one knee in
the wagon, and with tlie other knee began propelling himself up the short hill
to the sidewalk. About halfway up, the weight seemed to be too much for him.
He struggled hard. Then he rolled out of the wagon, sat down on the ground
with a helpless air and held the wagon in place with both hands on the back
end of the wagon. He sat behind the wagon with an expression of futiUty. He
rolled over on his side till he was at the side of the wagon and held on. The
wagon rolled back slightly.
9:45. With one hand he picked up a clod of dirt. He seemed to be angered at
the difficulty he was now having with the wagon. He threw the clod into the
ditch and shouted angrily, "Damned old mud!" He sat for a moment and
glared at the muddy ditch [Barker and H. Wright, 1948-51].
That there are triumphs in the lives of persons with disabilities, triumphs
that arise in disability-connected situations, is just as important as the fact
that there are suffering and failure.
In Wally's case, as he sat throwing the clod and casting imprecations
at the mud, new ways to solve the problem began to dominate his atten-
tion, ending in victory.
9:45. Wally rolled over and, using the wagon as a prop, lifted himself up.
With what seemed renewed determination, he put one knee in the wagon and
with the other foot started to push the wagon up the hill. Since it was difficult
for him to go directly up the hill, he tried to lessen the grade by taking a
diagonal path up the hill. He turned the wagon to the left and pushed hard.
He got caught in some weeds oflf the path along the side.
9:46. It was quite a struggle but he kept pushing strenuously. He rolled out
of the wagon and tried to push the wagon with his hands. He pushed it up and
tried to crawl up behind it but this was difficult because the wagon would not
stay up; while he crawled, the wagon rolled back down. He had to block it
with his body to prevent it from roUing all the way down the hill. Wally looked
up at me [the observer]. He was getting quite annoyed at the whole procedure.
He asked hopefully, "Will you pull me up?" I asked him kindly, "Well, what
would you do if I weren't here?"
9:47. He smiled quizzically and coaxed, "Pull me up." I said, "Well, would
you puU up yourself if I weren't here?" Again he smiled. He turned around
with what seemed a little more determination. He put one knee in the wagon
and, with a great effort, strenuously pushed the wagon up. The wagon moved
up the hill. He looked at me and said determinedly, "I'm getting up," as though
he were showing me that he could do it himself if I weren't there. After a good
6 Physical Disability — A Psychological Approach
deal of struggling he finally pushed the wagon up onto the cement sidewalk.
When he got it up onto the cement sidewalk, he gave one final hard push.
9:48. The wagon suddenly moved forward on the sidewalk and he fell flat on
his stomach. He accepted this matter-of-factly. He crawled up to the wagon
and got in it. Then he turned around, looked at me and said with pride in his
voice, "I made it" [Barker and H. Wright, 1948-51].
So it was with the others. Russell Criddle, once rejected as a dating
partner, eventually met the girl he was to marry. Louise, once denied a
job because of her crippling, persisted until she found work to her liking.
We do not wish to imply that all ends well in the lives of persons with
disabilities, but we do wish to emphasize that satisfactions, and not sor-
rows only, are well represented.
Difficulties and triumphs, some having their source in the person him-
self, some primarily in the social environment — these will crop up at
every turn of our exploration into the factors that serve man and those
that hinder him in his eflforts to live effectively and comfortably with a
disability. Problems and solutions arising from the social and personal
evaluation of a disability are discussed in the first half of the book (Chaps.
2-10). The more clinical chapters, those concerned with the way in which
the person may be effectively encouraged in the rehabilitation setting to
meet the challenges imposed by disability, come toward the end (Chaps.
11-14). The parent is the central figure in Chapter 12, the child in
Chapter 13, and the adult client with a disability in Chapter 14. Through-
out, attitudes and their origins are examined critically, for these are the
springboards for a good deal of behavior as well as crucial leads to a
person's inner life. Those sources of attitudes that did not naturally come
into the discussion of specific problems are brought together and discussed
in Chapter 10. The last chapter reviews the heritage of somatopsychology
in the diverse efforts, past and present, to relate personality to physique
and underscores the findings and conclusions that appear essential in the
overall evaluation of the field.
We have not attempted to cover the literature; for this the reader may
refer to such reviews as Garrett (1952), Barker et al. (1953), and Meyer-
son (1957).^ The varying emphases and not infrequently divergent con-
clusions of the reviewers are worth more than a passing thought. At
^ The following are fine bibliographic sources for somatopsychological
literature: Rehabilitation Literature (National Society for Crippled Children
and Adults, Chicage, 111.), issued monthly, maintains the most comprehensive
abstracting service of current literature: Psychological Abstracts (American
Psychological Association, Washington, D.C.), issued bimonthly, has a section
entitled "Physically Handicapped." An excellent source of information about
on-going research is the Bio-Sciences Information Exchange at 1113 Dupont
Circle Building, Washington 6, D.C.
Circumscribing the Problem 7
several places in this book we have attempted to take divergencies into
account as well as to account for them. Research findings and the con-
sidered opinions of others have generally been introduced as they bear
upon the issues under discussion.
In the main, the problems and issues studied in this book have applica-
tion to children and to older persons, and to persons with various dis-
abilities. Most typically, the discussion draws its concrete demonstrations
from different age levels; where it does not, its application across age
levels is usually apparent. Sometimes it seemed more expedient to center
the discussion on one or another age group, either because the problem
seemed more directly relevant to a particular population segment or
because the research and illustrative material dealt with subjects of certain
ages. The same holds true for specific disabilities. The example may refer
to a person with an amputation, paralysis, or a hearing impairment, but
it is used only to make explicit a principle or point that has wider gener-
ality. The psychological problems surrounding mental retardation as such
are not dealt with, although it should be noted that a good deal of the
discussion has application to mental as well as physical shortcomings.
TERMINOLOGICAL ISSUES
Semantics has insistently pointed out that words and the ways in which
they are put together play a large part in the continued misunderstandings
of interpersonal relations and of psychological and physical facts (see
Johnson, 1946; Korzybski, 1951). Several documents utilizing examples
from diverse groups — primitive cultures and our own — show that language
is not merely an instrument for voicing ideas but that it also plays a role
in shaping ideas by guiding the experience of those who use it (see Whorf,
1947; Lee, 1947; Sapir, 1931; Korzybski, 1951). It behooves us, there-
fore, in studying the psychology of disability, to give serious attention to
the problems and implications of word usage.
Dangers of ShorS- Cuts
Is a physically disabled person one who is unable to do anythmg? Of
course, this is an absurdity that calls forth the rebuttal that the designa-
tion is meant to refer to varying degrees of disability and not just to the
extreme. More accurately, then, a physically disabled person is also a
physically abled person. There are things that he can do as well as things
that he cannot do. We may conclude that the designation "a physically
disabled person" is a short cut to the more involved but psychologically
sounder expression "a person with a physical disability." Such a reformu-
8 Physical Disability — A Psychological Approach
lation is far reaching, for it connotes that a person with a disability is first
a person with many unspecified characteristics in addition to a particular
disability. A tolerant concurrence, combined with the feeling that this is
much ado about nothing much, may greet this proposal; but, as we shall
see in subsequent chapters, it is precisely the perception of a person with
a physical disability as a physically disabled person that has reduced all
his life to the disability aspects of his physique. The short cut distorts and
undermines.
This is probably one major factor that gives to the words "disabled" and
"handicapped" a derogatory connotation. It is reported that a woman,
herself diabetic, who had been speaking energetically on discrimination
in the employment of diabetics and their difficulty in obtaining insurance
protested violently when National Employ the Physically Handicapped
Week was mentioned, with the assertion, "I do not consider myself handi-
capped" (Rusk and Taylor, 1946:111). She readily acknowledged her
physical handicap, but she was reluctant — and rightfully so — to consider
all of herself handicapped.
Titles of books and articles may well take into account the difference
in connotation between the short cut such as "The Physically Handi-
capped" and the more careful reference, "Persons with a Physical Handi-
cap." To be sure, the structure of our language makes it difficult to carry
out this principle in all instances. Persons who are blind will still be
referred to as "the Blind" as though in all significant matters this were
the main identifying feature. As wUl be seen later, there is a tendency,
where characteristics conveying status implications are involved, for
inferiority on one scale to spread to total inferiority of the person. Since
physique does stimulate value judgments, it is particularly important to
use expressions insofar as feasible that separate physical attributes from
the total person.
Disabilily vs. Handicap
We may now wonder wherein lies the distinction between the socalled
physically disabled and the physically normal, since omnipotence is not a
property of any creature on earth, and all of us must function within
more or less defined limits. It might be suggested that the concept of
physical disability implies deviation from a normal standard, deviation
from a state that is natural or average. But here again there are difficulties.
It could be asserted, for example, that the arthritic changes concomitant
with aging represent a "natural" course of events; yet hardly a person
would be ready to concede that the resulting extreme deformities are
nondisabhng.
Circumscribing the Problem 9
Hamilton (1950) proposes a distinction between the terms "disability"
and "handicap" that is helpful as a point of departure. "A disability is a
condition of impairment, physical or mental, having an objective aspect
that can usually be described by a physician. ... A handicap is the
cumulative result of the obstacles which disability interposes between the
individual and his maximum functional level" (p. 17). A disability, then,
is more particularly a medical condition, whereas a handicap more nearly
refers to the somatopsychological relationship previously described.
It is important that the implications of this distinction be pursued
further, for some clarity must be achieved amid the barrage of impres-
sions emanating from the terminology used. To begin with, it must be
recognized that not all conditions that may be described medically as
disabilities are perceived as handicaps. The bound and diminutive feet of
Chinese women were not felt to be handicapping among certain strata of
the Orient, where this condition symbolized nobility. An important clue
resides in the fact that the functional level of such a Chinese lady did not
require efficient locomotion. In other words, the determination of maxi-
mum functional level, or what the person needs and is expected to do,
itself partly depends upon the cultural setting in which the person lives.
It should be clear, then, that a handicap must be evaluated in terms of
the demands of the situation in which the person finds himself. In general
we do not consider children to be physically handicapped because their
physical abilities are less than those of adults. And, to draw upon an even
more pointed example, we do not consider aU mankind handicapped
because men are not as fleet as the deer, as strong as the lion, or able to
soar into the air. Similarly, even severe disabilities need not represent
major handicaps. For example, a blind person may not be handicapped in
work that does not require visual orientation; a person whose job does not
require rapid locomotion may find his wheel chair no more frustrating
than a bus ride is to the person who takes it for granted that he has to
ride a bus to work every morning.
Fielding (1950) investigated the attitudes of 40 women with moderate
to severe orthopedic disabilities resulting from poliomyelitis. Although the
disabilities were more than minor from the medical point of view, some
20 percent of the subjects affirmed that the disability at most annoyed
them very little in physical activities. Although 98 percent of the subjects
reported that they occasionally experienced the physical defect as a dis-
advantage, 70 percent also reported the defect to be a help in some phases
of life. These results cannot be discounted as mere products of wishful
thinking or subconscious rationalization. It is by now well corroborated
by research and theoretical consideration that disability as the term is
here used cannot automatically be equated with handicap.
Conversely, a person may feel physically handicapped even though from
10 Physical Disability — A Psychological Approach
the medical point of view his physical limitations are not disabilities. A
person who aspires to become a great singer although endowed with
but an ordinaiy voice is handicapped in that his physical attributes impede
his progress toward his goal. His maximum functional level is inadequate
to the functional level required by his aspirations.
There are indications that in our society, irrespective of medical or
"actual" disability, deep dissatisfaction with certain aspects of one's body
is almost universal. Levy {1932), for example, in talking with children
about matters pertaining to their bodies, fovmd that 18 of 20 children
exhibited sensitivity or a feeling of inferiority with respect to some aspect
of their physiques. It was not a physical disability in the medical sense
that proved handicapping to these children.
Finally, the obstacles that the disability interposes may be as much
social in character as physical. With some disabilities, as in facial dis-
figurement, the handicapping factors reside almost entirely in negative
social implications.
We are led to the interesting conclusion that a physical attribute is a
physical handicap only when it is seen as a significant barrier to the
accomplishment of particular goals. This means that, in the individual
case, a physical disability may or may not be a physical handicap. This
is also true of a physical attribute that is not a deviation. Moreover, a
physical attribute may become handicapping not because it is physically
limiting but because it adversely affects social relationships.
Physical Definitions and Psychological Understanding
One might suppose that the definition of the various disabilities would
not involve such semantic complications. Are not deafness and blindness,
for example, clear-cut disabilities? Actually, the problem of nomenclature
regarding these disabilities continues to arouse controversy. Deafness is a
case in point. One might suppose that all that is required is a reliable test
of auditory acuity — for example, diminishing the intensity or amplitude
of a sound until the subject no longer responds to it. Several issues, how-
ever, act against the uncritical application of this simple system. First, at
what point of diminishing sound intensity shall it be said that a person is
deaf, as opposed to hard of hearing? Shall the designation of deafness be
reserved for those whose auditory acuity is functionally useless? A Con-
ference of Executives of Schools for the Deaf (1938) did in fact adopt
definitions in functional auditory terms:
The deaf: those in whom the sense of hearing is nonfunctional for the ordinary
purposes of life. . . .
Circumscribing the Problem 1 1
The hard of hearing: those in whom the sense of hearing, although defective, is
functional with or without a hearing aid.
But then, of course, one has to set up criteria both for the evaluation of
functional and nonfunctional hearing and for what constitutes "the
ordinary purposes of life." To complicate the problem yet further, it has
been shown that two individuals with the same degree and patterning of
auditory acuity as measured by pure tone threshold may differ markedly
in auditory functioning as measured by speech-hearing tests (Barker et al.,
1953:191; Meyerson, 1956). Likewise, two individuals with similar audi-
tory functioning may display grossly divergent sensitivity to sound. These
interesting results occur because functional hearing depends upon many
factors other than sheer auditory capacity — e.g., motivation, age at loss of
hearing with respect to language acquisition, etc.
A similar situation exists in the case of blindness. The definition of
blindness varies from country to country, from state to state, and certainly
from investigator to investigator. A person is legally blind in Norway, for
example, if he cannot see to count his fingers in good illumination against
a dark background at a distance of one meter (Hoist, 1952). Within the
United States legal blindness is based on such diverse criteria as inability
to perceive motion at a distance of one foot and Snellen Chart perform-
ance of 20/200, which is roughly equivalent to the ability to read 14-point
type. Whatever the criteria, however, great caution must be used in infer-
ring from them what the person can and cannot do simply because there
is not a one-to-one relation between visual acuity and visual behavior.
Thus, in one study, 8 percent of the children in special classes for the
partially seeing had central visual acuity less than 20/200 Snellen, mean-
ing that they could be classed as legally blind — yet these children could
learn by visual methods (Kerby, 1952).
The proposition that physique as defined medically in physical or physio-
logical terms is not unequivocally related to behavior is an important one.
Definitions of physical conditions are not psychological definitions. Like
age or sex, they are of value in somatopsychological research chiefly as
reference points that delimit gross characteristics of the individuals to be
studied. They are the starting points for such crucial inquiries as: How
does the person evaluate his disability? What are the physical limits it
imposes? How does he feel that others see his disability and himself? How
do society and those more immediately close to him view his deviation?
These are somatopsychological questions that point to the underlying
dynamics or genotypical variables that coimect atypical physique, on the
one hand, with attitudes and behavior, on the other.
Before embarking on the main discussions of this book, it is especially
(2 Physical Disability — A Psychological Approach
important for the "able-bodied" reader to realize that the topics are not of
special moment to a different group but, rather, that they are of special
moment to the totality of mankind, for each of us must at some time face
the challenge of living with a disability. This is another way of saying that
physical disability is a "natural" and "normal" part of life, that all of us
experience illness, that time brings impairment. The next chapter initiates
the exploration of social-psychological conditions affecting adjustment to
disability by considering the powerful status implications of disability.
Chapter
Inferior Status Position
2
Some indivtouals deny the fact that persons with disabilities are
looked down upon. This protest has come not only from those who have
a disability but also from professional personnel, such as teachers and
rehabilitation workers, actively engaged in disability matters. Perhaps it
is felt that to assert the existence of inferiority as an attitude is to affirm
it as a fact. Public attitudes are often positive, but negative, deprecating
attitudes also exist, although these may be more covert. To recognize the
existence of the negative is not to be defensive or to add to it but, rather,
to be better able to effect countervailing changes.
If a person with a physical disability is unable to participate in some
activities that are highly valued, his space of free movement is felt to be
restricted. Part of the restriction may be due to the physical limitation
itself. A person who is deaf will not enjoy a concert. A person with limb
oi heart impairments may avoid walking more than modest distances. But
part of the restriction has its source in socially derogatory attitudes —
attitudes which say, in effect, "You are (or I am) less good, less worthy
because of the disability. It is something to be hidden and made up for."
Devaluation is expressed in various ways. It is seen in the patronizing
attitude of the person who gives money to "help those poor little crippled
children." It is seen in disparaging allusions to the physical particulars of
an adversary. Jokes about disabled persons more often deprecate and
ridicule than do jokes about other classes — e.g., farmers, salesmen, judges
(Barker et al., 1953:15). The feeling "I am glad I am not like you,"
which not infrequently springs into consciousness as a reaction to a person
with a disability, betrays devaluating attitudes. We do not entertain this
feeling toward persons whom we accept on an equal or superior footing,
even though we might not choose to exchange places. In an extreme form,
devaluation is seen in aversion toward a person with a physical disability.
The following is one incident among many variations on the same theme:
disability leads to devaluation. Karen, a three-year-old child with cerebral
palsy, journeyed far with her parents for medical consultation. They were
seeking lodging for the night:
. . . The house was lovely — white clapboard, old and with lamplight at the
'3
14 Physical Disability — A Psychological Approach
windows, it looked warm and friendly. I rang the bell and the door was opened
almost immediately. I stepped in out of the rain and turned to a sweet-looking
middle-aged woman.
"We should like a room for the night," I said, "if you can put a cot in our
room for Karen."
"I think I can accommodate you."
She led the way into a tastefully furnished living room and invited me to sit
down. I relaxed comfortably, propping Karen on my arm. . . .
"Why don't you put the child down, she must be heavy," she inquired.
"That's all right," I said, "I'll hold her."
"Well, sit her in the chair next to you," she suggested, "I don't mind if she
gets down and runs around. Traveling is hard on youngsters; she'd probably
love to get down."
"Karen can't get down and run around," I explained. "As a matter of fact,
she can't sit up alone. Even when I'm holding her you'll notice she has difficulty
holding her head erect for any length of time. That's why we're here. We've
come to see Dr. C. We hope he may be able to help her."
I suddenly realized that the woman was sitting in an attitude of frozen atten-
tion. Her face grew livid and she jumped to her feet. "Get out of my house!"
she shouted. "Only bad, dirty people would have a child like that" [Killilea,
i952.-64-65].i
Self -devaluation as felt by the person with a disability is also manifested
variously. Illustrations of its many ramifications appear in this and other
chapters.
Physical limitations per se may produce suffering and frustration, but
the limitations imposed by the evaluative attitudes toward physique cut
far deeper and spread far wider; they affect the person's feelings about
himself as a whole. One of man's basic strivings is for acceptance by the
group, for being important in the lives of others, and for having others
count positively in his life. As long as physical disability is linked with
shame and inferiority, realistic acceptance of one's position and one's self
is precluded. We might add and underscore that as long as a physically
able person holds this linkage, he is ill prepared for the time when he too
will be in the position of meeting disability. It behooves us, then, to give
careful consideration to the sources of such feelings, ways of reacting
to them, and ways of adjusting to them.
COMPARISON WITH MINORITY GROUPS
Underprivileged Status
The position of persons with a disability has been likened to that of
1 Reprinted with permission of Prentice-Hall, Inc.. and Staples Press, London,
from Karen by Marie Killilea. Copyright 1952 by Marie Lyons Killilea.
Inferior Status Position 15
underprivileged ethnic and religious minority groups (Barker, 1948). For
example, employment opportunities, particularly at the higher levels, are
sharply limited. Many employers as a matter of policy establish physical-
fitness standards for all employees irrespective of whether a particular job
can be handled effectively by a person with a disability. Yet Henry Ford
(1926) stated that "we are too ready to assume without investigation that
the full possession of faculties is a condition requisite to the best perform-
ance of all jobs" (p. 107).
Likewise, the social and recreational activities in which persons with a
disability are able to engage are frequently restricted. Even should the
person be accepted as a participating member in many life areas, his
disability is often seen as precluding marriage. In one study of 50 college
students, 65 percent stated that they would not marry a person who had
an amputated leg, and 50 percent stated that they would not date such a
person; 85 percent stated that they would not marry and 72 percent that
they would not date a deaf person (Rusk and Taylor, 1946:219). This
is social ostracism of the sort experienced by ethnic and religious minori-
ties.
Moreover, many members of the favored majority wish and frequently
insist that the minority-group member not only know his place but also
keep his place — that is, that he feel and act like a less fortunate being.
Certain of the driving forces behind this insistence have been coordinated
under the concept "requirement of mourning," elaborated on pages 242-
243. Here let it suffice to point out that the requirement of mourning
stems from a need on the part of the majority-group member to maintain
unchallenged those values which he cherishes, and which have given him
elevated status. This dynamic is captured in the astute observations shared
with Chevigny {1946), recently blinded, by a friend who said, "You're a
blind man now, you'll be expected to act like one [p. 71]. People will
be firmly convinced that you consider yourself a tragedy. They'll be
disconcerted and even shocked to discover that you don't" (p. 74). Aren't
some people disconcerted and even shocked when ethnic and religious
minority-group members advocate equality or show in other ways that
they feel as worthy as the next man?
A study dealing directly with the hypothesis that disability groups are
viewed in certain ways as minority-group members (Co wen, Unterberg,
& Verrillo, 1956) analyzed correlates of attitudes toward blindness. The
investigators found that negative attitudes toward blindness correlated
significantly with antiminority, anti-Negro, and pro-authoritarian attitudes.
These findings were essentially replicated in a cross-validating sample,
thus confirming the underlying hypothesis.
16 Physical Disability — A Psychological Approach
Overlapping Situations
The person with a disability, like the members of other minority groups,
may be represented in certain instances as subject to two different and
often conflicting situations at the same time. On the one hand, being
considered a disabled person by himself or others, he is subject to the
behavioral mores and expectations of the disabled group (disabled deter-
minants of behavior) ; on the other hand, his wish or the wish of others
that he is "just like anyone else" predisposes him toward "normal" pat-
terns of behavior. 2
Illustrative of the problem is the situation of persons who are blind. As
Chevigny {1946) has stressed, the world has an unusually fixed notion
that a bhnd person is a tragic figure, utterly helpless and dependent. This
is one situation in which the blind person finds himself. The other situa-
tion is more clearly that of a normal person, with its attendant values and
expectations of independence and self-respect. A person who is blind may
not only prefer to be in the latter psychological situation but may
actually feel that he is, to some extent or fully, a part of it. He may, for
example, consider his lot to be not at all tragic. He may have achieved
an adequate degree of physical independence and his share of life's satis-
factions. Instead of regressing into helplessness and self-pity, he strives to
maintain a reasonable amount of independence from people and things
and to carry out adult responsibilities. Yet he is subject to the behavior
determinants of both the "disabled" and the "normal" situation. When he
seeks a job, society may direct him to the sheltered workshop even though
he may feel able, or at least wish to try, to compete in the world of
normal persons (see Criddle, 1953: Chaps. 21, 22). In ordinary relation-
ships, people may insist that he act like a blind person and may be "dis-
concerted and even shocked when he doesn't."
The expectations and directives of others are not the only source of
conflict in overlapping situations. The person himself may be torn between
acting in terms of his disability and acting like a normal person. He may,
for example, find it necessary to slacken his pace when ascending stairs
while at the same time he may wish to hide his handicap and keep up
with others. Of course, whether the conflicting situations are felt to be
imposed by the outside or are felt to stem from internal conflicts makes a
difference as to where the individual's resentments will be focused. In any
case, a person with a disability — and, in fact, all members of minority
groups — may frequently be placed in overlapping situations, both by
2 A systematic discussion of the nature of overlapping situations and resulting
behavior is given in Barker et al. (1953:27-46). Although the referents are to
physical growth in adolescence, the points made have wide generality.
Inferior Status Position 17
society's edict and by personal conflicts, in which the determinants of
behavior are to some extent incompatible.
Group Stereotypes
The stereotype of a person with a disability typically describes one who
has suffered a great misfortune and whose life is consequently disturbed,
distorted, and damaged forever. Unlike the bereaved person, in whom the
pain of loss formally ceases after a year and who is expected gradually to
reap once again the fullness of life, the person with a disability is expected
to be permanently enmeshed in the tragedy of his fate. Several factors
contribute to this stereotype. In addition to the phenomenon of "spread"
(p. 118), the "requirement of mourning" (p. 242), and the sources of
attitudes examined in Chapter 10, popular misconceptions are perpetuated
by the distortions of reality appearing in mass media.
Guilty of confirming pity stereotypes, popular culture finds ample use for
them. Typical was the film Moulin Rouge, which depicted Toulouse-Lautrec as
a piteous, embittered dwarf, morbidly obsessed by his deformity and tragic in
his love relationships. How far this is from the truth can be seen in Gerstle
Mack's biography, where the artist emerges as a witty, engaging personadity
who loved Paris night life and the sporting scene. The testimony of Lautrec's
friends indicates that, with the exception of his last mentally aberrant years, he
was amusing and well liked, highly regarded by the artistic and literary figures
of his time. By falling into easy stereotype, the film distorted the facts of
Lautrec's life to play up sentimental fancies and, unwittingly, to confirm
popular notions of how the handicapped are handicapped [Maisel, 1953:32].^
Where the social stereotypes of a group are stigmatizing, the individual
often wishes to be judged in his own right and not "known" by his
membership in the group. The reason for this is not hard to find, for the
stereotyped evaluation of himself as a person and the stereotyped interpre-
tation of his behavior often reflect underlying devaluating attitudes. Con-
sider some common negative misinterpretations: A person with a
disability is often considered to be compensating when he may merely be
interested; he is assumed to be feeling inferior when he may merely be
holding back because of realistic appreciation of his limitations; he is
regarded as being suspicious when he may merely be wondering — all
because he is seen as part of a larger group with certain presumed person-
ality characteristics.
The dependence of a part on the whole does not always result in the
part's taking over or assimilating the properties of the whole. Sometimes
3 Edward Maisel. Meet a Body, by permission of the Institute for the
Crippled and Disabled. Manuscript.
18 Physical Disability — A Psychological Approach
the influence is seen through the phenomenon of contrast. Suppose, for
example, that a deaf person earns a living and is happily married. He
may be judged by others as outstanding in his accomplishments and
unusually well adjusted, simply because his behavior is perceived as con-
trasting with the stereotype about the deaf. The person himself may resent
such accolades because he is aware that they actually depend upon
devaluation of the group of which he is inextricably a part. Praise of him
is merely a case of the exception proving the rule. "In the same way do
we judge the personality traits and motivations of individual Jews, Re-
publicans, Negroes, Catholics, Russians, etc. . . . Thus, many Ameri-
cans, through the operation of the assimilation phenomenon, tend to
overestimate the shrewdness of a particular Jew, or the inscrutability of a
somewhat reticent Russian — because they believe Jews to be shrewd and
Russians to be inscrutable. Because of contrast, they tend to overestimate
the intelligence of a Negro who is normally intelligent and to under-
estimate the religious conservatism of a Catholic who is liberal in some of
his religious views" (Krech and Crutchfield, 1948:97).*
Assimilation appears when the difference between subparts of the whole
is perceived as small, contrast when it is perceived as great (Heider,
1944). It can be expected, therefore, that a person with a disability will
have to cope with the phenomenon of assimilation more frequently when
interacting with a stranger than with a close friend, for in the latter
instance he is known as an individual, which makes him, though part of a
group, different to some extent.
But the plea "Do not judge me by my brothers" cannot be followed in
every respect because the individual must be apprehended in terms of the
presumed characteristics of the group of which he is felt to be a part.
This is not merely up to the whim of the perceiver, for experimentation
has clearly shown that the perceived properties of a substructure are
largely determined by the nature of the whole structure. But although we
may never be able to avoid organizing individuals into groups, "there is
no reason demanding that only certain defined personality traits should be
perceived as 'belonging' to any specific grouping based on such differentia"
(Krech and Crutchfield, 1948:98).
Differences in Minority-Group Position
Although it is important to understand that a person with a disability
* The effect of the part-whole relationship on elementary perception and the
perception of personal characteristics has been elaborated by Heider {1944),
Krech and Crutchfield (1948), and others. Quotation from D. Krech and R.
S. Crutchfield, Theory and Problems of Social Psychology, McGraw-Hill Book
Company, copyright 1948, by permission of the publisher.
Inferior Status Position 19
often shares problems in common with members of other minority groups,
there are some marked differences. One of the most significant is that he
rarely has the kind of group sanction and personal valuation that endorses
behavior reflecting the disability. Rather, the typical advice is to appear
as much like a nondisabled person as possible, and his adjustment is often
measured in terms of his skill as an actor. Even where there is a high
degree of acceptance of the disability, there is a resistance against
behavior that unnecessarily spotlights the handicap. This is clearly seen
in the following account by the mother of a blind child. On the basis of
interviews, this mother was rated as showing good acceptance of the child
and her handicap:
We helped Mildred to overcome some of her mannerisms which are some-
times associated with blindness such as hanging her head. We explained to her
that this habit was characteristic of the blind, and she earnestly tried to over-
come it. We also discussed with her the frequently expressionless and vacant
look on the faces of the blind, particularly when listening to speeches, etc. We
tried to tell her that she must make an effort to show joy or sadness, surprise
or disappointment. She seemed to appreciate and understand this when we
explained that it would increase her personal attractiveness [Sommers, 1944:52].
In contrast, a Jew or a Negro, for example, can take pride in many of
the characteristics held to be uniquely Jewish or Negro, and such pride
is looked upon as a sign of self -acceptance.
In addition, the minority position of the person with a disability is not
likely to be closely shared with other individuals. Of primary importance
is the fact that physical deviation does not generally continue from genera-
tion to generation, as do other minority-group characteristics. Certain
racial characteristics are genetically inherited; religious characteristics are
socially inherited; but a person with a disability is often the only one in
his family so affected, and hence he may lack the family identification that
members of other minority groups usually have. As a child he may be
unaware that there are other individuals with a disability like his and thus
he may feel no affiliation with any minority group at all. Moreover, clubs
and groups organized by and for persons with disabilities are rare in
small communities. In the case of other minority groups, the psychological
situation is often very different. A Jew or a Negro who lives in a com-
munity in which he is the only member of his group may psychologically
be a member of the larger group, sharing in its aspirations, accepting its
values, and participating in its activities. But the person with a disability
is often an isolated individual who must meet the limitations imposed by
underprivileged status with but minimal support of group identification.
The underprivileged-minority position of persons with a disability
20 Physical Disability — A Psychological Approach
creates difficulties of two kinds. There are the hardships and suffering
resulting from the restrictions imposed by the dominant majority. There
are also the person's devaluative feelings about himself and his handicap.
Although not all persons with a disability have such feelings, many do,
and probably all have at some time during the course of their adjustment.
It is to the suffering and pain associated with shame and feelings of in-
feriority that we shall now turn our attention.
MANIFESTATIONS OF LOWER-STATUS POSITION
Shame, self-pity, and inferiority are difficult psychological states, and
the person will muster varied and persistent efforts in order to overcome
them. The effort to raise one's self-esteem may be directed toward one's
own self-acceptance, or toward hiding or weakening one's identification
with the devalued group. This problem has been explored by Dembo and
her associates (1956), the main outlines of their analysis being reflected
in the discussion below.
"As If Behavior
In the effort to adjust, the person commonly tries to conceal his disability
— and for understandable reasons. The person typically views his dis-
ability as does the normal majority. If it is taken for granted that a dis-
ability is something to be ashamed of, the obvious way to eliminate shame
is to eliminate the fact of disability. Where this can be realistically ac-
complished through surgical and other therapeutic procedures, the person
will feel relieved, and objectively he may effect a change from the handi-
capped to the nonhandicapped position. Where this cannot be accom-
plished, however, the person will attempt to hide, forget, or even deny
what to him is a deficiency. The need to cover up in order to be acceptable
as a person may be so strong that, even when the deviation is minor and
temporary, the person may fumble his way through patent devices: thus
17-year-old Chip, who recently had an eye tooth extracted, "went about
grinning with his tongue turned over to cover the almost unnoticeable
gap" (Linduska, 7947.128). The person may even succeed in denying
painful facts to himself. The psychoanalytic literature on repression leaves
no doubt that the escape forces may be so strong as to alter one's memory
and perception of the unacceptable.
We do not wish to imply that all efforts to cover up stem from personal
depreciation. A person may fully accept a particular fact about himself
and yet conceal it because of the belief that awareness on the part of
others would contribute to disturbed social relations. This is one basis on
Inferior Status Position 21
which the cosmetic hand instead of the hook or no prothesis is recom-
mended in casual relationships (Dembo and Tane-Baskin, 1955). Real-
istically recognizing that the knowledge that one is a Jew, or an amputee,
or hard of hearing may create social barriers to full acceptance by others;
one may therefore not call attention to these facts even when it would be
natural to do so.
In many such instances, however, the person does harbor depreciatory
feelings about his minority-group status, for otherwise complete accept-
ance by the majority would not be crucial. In this case, concealment may
draw its complete sustenance from the conviction that having a disability
makes the person less wanted, less good. Consider the following autobio-
graphical reminiscences. Frances was hard of hearing. As a small child
she heard her aunts, who reared her, speak about a neighbor as "so stone-
deaf he might as well be dead." In the value-atmosphere of the home, she
began to see physical perfection as the royal road to success in all areas
of life, including one of the most important, that of love and acceptance
by others:
"Stop slipping your braces oflf," Aunt May said. "If you have crooked teeth
you'll be sorry."
"Stop reading all the time and ruining your eyes," Aunt Harriet scolded. "If
you have to wear glasses, you'll be sorry."
"Stop eating so much fudge; your complexion's bumpy, you're much too
plump. Don't you want to be slender and beautiful and marry into a fine
family like your oldest sister?"
"Stand up straight. Don't you want to be athletic like your second sister who
is so popular and is invited everywhere?"
"Brush your hair a hundred strokes every night. Don't you want to have
thick shiny braids like your sister Ann's?" [Warfield, 1948:22].^
Frances, then, had no alternative but to conceal, however precariously,
the fact that she couldn't hear well:
I mustn't let on I couldn't hear perfectly. People didn't like it. It made them
scornful like Ann or exasperated like Aunt May and Aunt Harriet when they
called and I didn't answer right away. . . .
I must listen hard. Sometimes, when I didn't hear at first, it would flash over
me, a second later, what had been said. I must never look blank. No matter
how much I wanted to, I must never say "What?" "What?" was perilous.
"What?" would give away my secret and I'd be exposed to deadly danger [pp.
4-5].
5 F. Warfield, Cotton in My Ears, New York, Viking Press, Inc. Copyright
1948 by Frances Warfield.
22 Physical Disability — A Psychological Approach
For Frances the deadly danger was being rejected because of her deaf-
ness, perhaps even sent away. And this rejection was expected by Frances
and even supported by her because she agreed that deafness made a
person unworthy, that a hearing loss was something to be ashamed of.
Since a shameful fact cannot be accepted as long as it remains shameful,
Frances tried to hide, deny, or at best compensate for her hearing loss. It
was only later, after Frances discovered the futility of her pretense, that
she began to reevaluate the meaning of disability.
The effort to forget one's disability is supported by the presumption
that relief from the intolerable state can be achieved by blotting it out or
by acting as though it did not exist. If in some magical way one could
only forget, one could then act like a normal person — and be, in fact, a
normal person. This kind of magical thinking is displayed more clearly
in devised rituals which, if followed exactly, will reward the performer.
Frances, for example, "knew" that she would get her hearing back after
her adenoidectomy at seven, but just to make sure she secretly pursued
the rites of magic:
. . . Crouched in my hideaway behind the lilac bushes in the yard, I closed
my eyes and put my fingers in my ears and repeated, "wrinkelstiltskin" seven
times every day. I even devised fancier magic, such as avoiding cracks in the
pavement and touching every other railing of every fence I ever passed [War-
field, 1948:12].
The fact that unrealistic and even fantastic attempts to overcome dis-
ability are clung to tenaciously may be due to a deep emotional need for
their promised effects, but the choice of a particular mechanism emerges
from a conscious or unconscious belief in the reasonableness of its action.
All of us have at one time or another achieved solace in forgetting; all of
us have sought relief in sleep, an escape from the immediate troubles that
beset us, an interlude during which we consciously forget. All of us have
attempted to conceal or deny some personal fact: the child refuses to
admit that he took the candy; the young mother closes the door on the
unmade beds. In so doing we may sometimes have successfully shielded
the shameful fact from becoming a social reality. It is the social reality of
an undesirable personal characteristic, awareness of it on the part of
others, that threatens one's group status. To attempt to hide, to deny, to
forget is common sense, although it does not make adjustive sense. It
does not make adjustive sense because acceptance of a disability requires
that the person absorb it within his psychological outlook in such a way
that it is no longer a painful fact that must be concealed.
Even the more clearly magical ruse undoubtedly originates in some
experience that makes it "logical." When Frances at the age of 7 realized
Inferior Status Position * 23
that her operation did not produce clear hearing, she decided that when
she started school she would have perfect hearing because lightning would
strike her kite and restore her hearing! On the face of it, this seems truly
magical. But to Frances, it was completely comprehensible because "Aunt
Harriet had read a newspaper story aloud to Aunt May about a woman
who had been sitting beside an open window during an electrical storm
with a pair of scissors in her hand. Lightning had struck her scissors.
According to the newspaper story, the woman had been somewhat deaf,
but when her scissors were struck by lightning her hearing was restored"
(Warfield, 1948:15). Even Frances' choice of a kite was not accidental,
for she had admired a life-size statue of Benjamin Franklin and dreamed
of herself discovering electricity and being so acclaimed. It is the com-
mon-sense feel of these techniques as paths to the goal of full membership
in the favored group that leads the person to persist in using them in the
face of objective facts which negate them.
The attempt to conceal the disability, to act "as if," demands ingenuity
and alertness, for the situations that require covering up are endless. Again
let us share Frances' life (Warfield, 1948):
... I had never even felt faint, really — ^just a sickish little ball of panic in
the pit of my stomach sometimes when I wasn't hearing and was afraid some-
one was going to say, "What's the matter — cotton in your ears?" The dress-
maker who made my wedding dress had kept mimbling and mumbling, down
on the floor with her mouth full of pins. Several times during the fittings I'd
pretended to feel faint to explain my not answering her. Feeling faint was a
good alibi [p. 19].
I heard better when I could see people's faces; ... In firelit rooms or on
summer evenings on the porch, I would fall into reverie or pretend to go to
sleep. I knew dozens of ways to get people to repeat what they had said
without actually asking. For example:
Aunt May: "Will you remember to bring me some wrinkelawreedles on your
way home?"
I (dreamily) : "From the post office?"
Aunt May (tartly): "Since when does one buy darning needles at the post
office?" [p. 21].
I tried hard to be as funny as possible all the time. I invented a sidesplitting
story to explain why I took Aunt Harriet's crochet pattern to Mrs. Schlee
instead of to Mrs. McGee. I was a daydreamer and a woolgatherer; I faked
absent-mindedness, boredom, indifference [p. 21].
I had learned by experience to do all the talking when I walked along the
street with a boy. Indoors I could keep voices raised by playing the victrolaj
outdoors I was in danger of missing what was said. I always walked fast,
24 Physical Disability — ^A Psychological Approach
rattling on at random, trusting to luck that when a boy wanted to ask me to a
dance he'd call me on the telephone [p. 24].
I didn't mind being teased about snoring, because I snored purposely. Stella
[my roommate] was a great whisperer after lights were out and sleep was my
alibi for not answering [pp. 29-30].
Musical shows were all right; there was plenty to see and the plot didn't
matter. Plays dragged; I'd get bored imagining, and itch to know what the
play was about. Naturally I never asked. During intermissions I might inquire
oflfhand what Stella thought would happen next; with luck I'd get an inkling
of what had already happened. That is, if I heard what Stella said [p. 34].
The price of trying above all to hide and forget is high. It is high
because the effort is futile. A person cannot forget when reality requires
him to take his disability into account time and again. The vigilance re-
quired for covering up leads to strain, not only physically but also in
interpersonal relations, for one must maintain a certain distance in order
to fend off the frightening topic of the disability.
There is ample evidence in autobiographical materials to support this
thesis; yet objective observations are largely lacking. What little there is
remains unclear. Landis and Bolles (1942) hold, on the basis of inter-
views with 100 handicapped women, that those using the "obliterative
method" of adjustment (refusal to admit that they were incapacitated in
any way, equivalent to our "as if" behavior) showed the best adjustment
to handicap and general life adjustment. But the likelihood that these
same subjects would also deny any other difficulties, thus leading inter-
viewers to form a spuriously high impression of their adjustment, as well
as other considerations, prevent our relying upon these observations (see
pp. 135-136).
On the basis of our thesis, the following paradox becomes clear: Trying
to forget is the best way of remembering. In trying, one must be ever
aware of one's disability, for otherwise the disability might not be ade-
quately concealed. Physical disability remains a dominant value for the
person in most situations. On the other hand, to be able to submerge
disability-connected matters in situations in which they are not relevant,
the person must first recognize and accept the disability.
Idolizing Normal Standards
The efforts of the person to forget or cover up his disability in his
fervent hope of being "normal" also have important consequences for the
standards and values that guide his behavior and evaluations. It is under-
standable that, in the event of a disability, the person cannot simply revise
his standards that determine his aspirations and the way he feels about
Inferior Status Position 25
things. He cannot simply decide, for example, that it is all right for him
to limp, when he has always regarded the normal gait as the only really
proper way to walk. If, with the injury to his body, his value system
automatically underwent appropriate accommodations, he would be able,
for example, to see beauty in the laboring locomotion of a person who is
meeting the residuals of polio and to view the hand prosthesis as "working
hands" rathsr than "claws." Although such perceptions reflect good
adjustment to disability, they require major alterations within the value
system of the person, alterations that are only gradually realized in the
struggle for adjustment (see Chap. 5). An individual does not lightly toss
over the basis for strivings and evaluations that he has taken for granted
during the foregoing lifetime. By the same token, an immigrant does not
leave his native customs behind when he comes to a new land.
The person with a disability clings to the standards of the normal
majority for another, very dififerent reason. We have seen that in the
primitive effort to forget and conceal his disability, the person feels that
he must act "as if" the disability did not exist. This means that with
respect to his own behavior he must act as much like a person without
the disability as possible; with respect to the behavior of others, he should
be treated like anyone else. In other words, the standards of behavior
relevant to the nondisabled are maintained or even enhanced as the ideal,
the guide for the person's own behavior and relationships with others.
Arbitrarily holding up "normal" performance as the model of behavior
unnecessarily commits many persons with a disability to repeated feelings
of failure and inferiority. Careful experimental work has demonstrated
that the experience of success and failure is largely independent of the
person's performance per se but is determined by his goals, expectations,
and aspirations (Lewin et ah, 1944). Usually people set their aspirations
near the top of their abilities. After success, goals are usually raised; after
failure, they are usually lowered. In other words, the level of aspiration
operates as a protective mechanism so that most persons, whatever their
abilities, experience success much of the time. Where normal performance
is unattainable, the person who idolizes this as the standard must suffer
the ignominy of repeated failure. Performance that may represent genuine
progress over past achievement may merit only dissatisfaction because it
is still far from the elusive but imperious normal ideal. Moreover, even
should the person with a disability achieve or surpass the standards of
normal performance, this by no means guarantees a success experience,
for as long as he views his disability as a stigma, he can have only the
feeling that at best he is an imperfect facsimile of a "nondisabled person."
Let us share part of Raymond Goldman's (1947) life for exemplifica-
tion. At the age of 4 he was stricken with polio. Laboriously he learned to
sit up, to crawl. At the age of 8 he was fitted with long leg braces. By the
26' Physical Disability — A Psychological Approach
time he was 12, he could walk straighter and faster and tripped less fre-
quently. At about the age of 14 he was fitted with half -leg braces and
could walk better than ever. Finally, he attempted the impossible and
succeeded. Contrary to the prediction of his doctor, at the age of 17 he
learaed to walk without braces.
And yet, though he triumphed over severe difficulties, though his gait
represented remarkable improvement over the years, his feeling of
achievement in situations where the normal standards remained ex-
emplary, as in contacts with girls, was abruptly replaced by the feeling
of shame and dismay. At the beach he swam early in the morning to
avoid people who would see his legs. "The very sight of my own un-
covered legs stabbed me to the heart" (p. 86). In the afternoons he sat
on the beach, in trousers and shoes. "I even made friends with a group
of fellows and girls of my own age who came down every afternoon, my
self-consciousness subsiding as I got to know them better; subsiding, that
is, to a certain point beyond which it could not go. When the girls were
present I didn't walk" (p. 89, italics added). ^ What had been true ac-
complishment in terms of progress was now seen as defeat and failure
because in this situation the normal standards of walking were glorified
into how one should walk.
Furthermore, idolizing normal standards serves to support not only
inferiority feelings but also guilt feelings. (The emotional syllogism by
which the cause of disability becomes associated with evil is discussed on
pages 258-261.) To the extent that the person attributes the wrongdoing
to himself, he will feel the uneasiness of guilt, though in a vague and
uncomprehending way because its source is unclear. Since the idolizing
of normal standards augments the severity of the disability by emphasizing
the shortcomings of the person, in the syllogism of emotional sequences
the wrongdoing responsible for the disability becomes correspondingly
accentuated. Guilt prospers. Moreover, as Franz Alexander has pointed
out (1938), guilt feelings and inferiority feelings tend to reinforce each
other. The person tries to escape inferiority feelings by denial and by "as
if" behavior, by ambitious competition, by resentment against an unjust
world, all of which make him feel guilty because of new wrongdoings. He
tries to free himself of guilt feelings by atoning or by inhibiting further
aggressions. Sometimes these devices make him feel weak and dependent,
providing a new cauldron for inferiority feelings. The vicious circle spirals
upward. As Alexander (1938) puts it, using the criminal as subject: ". . .
in order to escape inferiority feelings the criminal is driven to commit acts
which give him the appearance of toughness, bravado, and aggressiveness.
«The selections from Raymond Goldman, Even the Night, copyright 1947,
The Macmillan Company, are used with the permission of the publisher.
Inferior Status Position 27
But this behavior which seeks to avoid the Scylla of inferiority feelings
drives him into the Charybdis of guilt feelings" (p. 47) .
In some way the normal standards of behavior themselves may become
endowed with a quality very close to a moral imputation that it is right
and proper for one to walk or talk in a certain way. At least under certain
conditions, the shame of inferiority at being below standard is tainted with
the shame of guilt at violating an ethical code. Raymond, the boy crippled
through polio, in thinking of his youth poignantly compares his emotional
reaction to that of a culprit: "It is hard to believe that I am describing
the emotions of a youth who is guiltless of crime against society. His
frantic fear of human eyes could not be more terrible if he had robbed a
bank, committed murder, or escaped from a penitentiary. He is lame,
that is all; and his soul is fevered with a burning shame" (Goldman,
1947:66).
Idolizing normal standards, then, relegates the person to an inferior
position, not only objectively, in terms of a particular characteristic, but
may also do so morally, as a total person. In turn, the feeling of shame
and inferiority prompts "as if" behavior, which itself heightens the potency
of normal standards, for in the frenzy of emotional logic, the success of
forgetting, denying, and concealing requires that the person emulate the
styles and standards of the nondisabled. Thus, the means of extricating
oneself from more shame becomes the very means of submerging oneself
further. (In Chap. 5 we shall consider value changes important to the
acceptance of a disability that hold greater promise for the ultimate
realization of the self as a worthy human being.)
The possible positive consequences of maintaining the standards of the
"normal" majority must also be examined. It might be argued that the
ideal of normal performance provides the necessary motivation for
persistent effort to surpass one's existing condition, that without it the
person would be satisfied with a more awkward gait or a less pleasant-
sounding voice or a narrower range of activities than he could achieve.
Almost any autobiography documents the fact that the feeling of in-
feriority, fed by the normal ideal, can serve, in a wide variety of situations,
to prod the person to outdo himself. Some theorists even assert that all
accomplishment primarily reflects compensation for inferiority.
It is revealing to examine several incidents in the life of Raymond
Goldman (1947), the man who was both lame and hard of hearing, with
the following questions in mind: Could Raymond's accomplishments have
been brought about by driving forces other than the striving to be like a
"normal" person? At what price were his accomplishments made? What
were the positive implications for adjustment and what were the negative
consequences?
When Raymond was fitted with full-length leg braces at the age of 8,
28 Physical Disability — A Psychological Approach
the trying problem arose of motivating him to use them. Until then he
had had little feeling of inferiority. He did not miss the companionship
of other children his age, for they belonged to a world he knew nothing
of. He was the center of his own world, where everyone loved him and
took care of him. He not only had high self-esteem but did not think of
himself as having misshapen legs (see pp. 144-145 for a vivid example of
his lack of awareness of his deformity). When the braces were fitted, he
hated them. They hurt, and only because of the prodding and solicitous-
ness of his parents did he cooperate at all:
During that summer I wore my braces at least thirty minutes every day. I
dreaded and hated them and made little effort to learn to walk. For a few
weeks I would not attempt to walk at all, but sat down after they were put on
and waited miserably for them to be removed. . . .
Quite naturally I preferred riding in the gocart to pedaling the velocipede,
crawling to walking. But mother rose to the occasion. She tolerated ray atdtude
for a while, then became annoyed with me.
"Get up and walk!" she commanded me, handing me my canes. "You'll never
learn how to walk sitting in a chair."
I got up and practiced walking. Mother watched me, suffering, I am sure,
even more than I. Propping myself up with the canes, I swung one weighted
leg after the other, taking a step, resting, taking another step. The braces were
half as heavy as I was. After getting across the room and back I was spent; I
felt nauseated and dizzy with pain and weariness. Then Mother took off the
braces, laid me on the bed, removed my stockings and rubbed me well with
alcohol, gently patting the red bruises on my ankles and knees.
As the summer passed, the skin of my ankles became tougher and tougher,
calluses began to appear. I wore my braces longer than half an hour a day; I
wore them several hours. I got around the house — though I could not take the
stairs — and I walked a little outside after I was carried down the front steps
to the sidewalk. . . .
My happiness at entering school was all the greater when I learned that I
was not to wear my braces there. Six hours in them was more than I was
expected to endure. That torture would be reserved for late afternoons, after I
returned from school. If I got along well at school, I thought, perhaps Mother
would see the uselessness of wearing them and would throw them away. Mother
was just being stubborn about it. Anyone could see that I got along much
better without them. Without them I could crawl all over the house in the
time it took me to walk across a room with them on [pp. 30-32].
Then occurred a momentous experience that was to usher in a totally
new attitude toward himself and the world around him. At the age of 8/2
Raymond entered school for the first time. The ridicule and torment to
which he was subjected was overwhelming (see pp. 145-146 for the
description of this nightmare). The hammer of comparison beat into him
Inferior Stafus Position 29
the barbs of shame. The standards of the "norm" began to have for him
the character of a compelling ethic:
... I knew now that legs should be stout and shapely and that mine were
skinny and deformed. I knew that I should walk and could not. I learned indeed
that I was a cripple, a pariah among the strong and straight, an object of pity
to grown-ups and of scorn to children [p. 39, italics added].
Now that Raymond had suffered shame, his braces took on a new
meaning. Before, they meant pain to him, and a way of locomotion that
was less efficient than his tried and true method of crawling. Now they
meant a way of becoming like other children, of meeting the standards of
the normal majority, of escaping the pity due a disgusting, crippled boy.
Small wonder that after school he asked for his braces :
. . . Thereafter, day after day, week after week, month after month I
struggled to walk. I put on my braces as soon as I got home from school and
I kept them on until I went to bed. About forty pounds of boy, I dragged
twenty pounds of steel across the room and back, across the room and back,
holding myself upright with my canes. I must walk, I told myself, I must walk.
I must get out of that shameful gocart, out of the arms of people who carried
me. Of course I could do it! Hadn't I learned to crawl, even down the steps?
[pp. 39^0].
An important question is whether Raymond would have learned to walk
had he not been prodded by the horror of shame. Hadn't his parents tried
to motivate him with reason, kindness, and command, but with limited
success? And yet, we reply in the affirmative, relying on the emergence of
new needs that develop in new situations and that may remain free of
shame. Hadn't Raymond learned to crawl down the stairs when he was 6
in spite of great fear because he wanted to get there without being
dependent on others? And shame did not crawl along with him!
... I learned to climb up the stairs, but going down stumped me for a long
time. In the upper hall I would venture to the head of the long carpeted stair-
way and look down. It was as forbidding as a bottomless pit and I would turn
away only to return again and look down while I lashed my courage. If I
wanted badly enough to go downstairs, I called someone to carry me; but there
was no real satisfaction in that. ... I was at the top of a long flight of steps,
looking down, waiting to go down, held back by fear. Then, without conquering
my fear but in spite of it, I started down, head first, and kept on going until I
reached the bottom [pp. 12-13].
Likewise, it is highly probable that Raymond would have found it
unsatisfactory to have to wait until someone could carry him or wheel
him in school from room to room and sooner or later would have turned
30 Physical Disability — ^A Psychological Approach
to his braces, in spite of the pain, as a way of achieving greater mastery
over his environment. Walking might have been delayed, but, without the
catalyst of shame, accomplishment represents the rewards of triumph over
adversity unsullied by the sinking feeling that one is not yet up to par.
But, to press further, under such circumstances would Raymond have
continued toward maximum improvement? Would he, nine years later,
have defied the expert opinion of his doctor that he would never walk
without braces and suffered the sweat and tears it took to accomplish the
impossible? His doctor had said, "You ought to be satisfied" (p. 29).
Would a Raymond free of shame have persisted, "But couldn't I try it?
It couldn't do me any harm to try, could it?" We do not know. Perhaps
the inconvenience of repeated broken braces, of heavy gear, would have
led him to attempt discarding them. Perhaps not.
But even so, a challenging query is "So what?" Reducing the disability
in no way assures a better adjustment. There is already sufficient research
to establish as a fact that there is but little relationship between adjust-
ment and degree of disability (see pp. 53-54). Was the gain of walking
without braces worth the price of self-debasement? The feeling of inferi-
ority is painful enough, but when the normal ideal not only spurs the
person onward but also sparks deception and defeat, one wonders what it
all adds up to. The consuming desire to be like other boys led Raymond,
like a rat in a maze, to explore frantically first one blind alley, then
another.
Sometimes the gateway was labeled "Lie, and you will be like other
boys." For example, when Raymond was in the fifth grade, an idea came
to him as he was watching a telephone repair man climb to the top of the
pole by using the irons strapped to his legs. The next time Raymond was
asked what he was wearing on his legs, he answered, "Tree-climbers."
Sometimes the gateway was labeled "Treat me like anybody else, no
matter what!" This meant that he wanted not only to have the good
things in life enjoyed by other boys but also to suffer the punishment that
other boys received. One day he set out upon a deliberate campaign to
change his teacher's attitude toward him from one of gentleness to that
of the strict disciplinarian she was to all the other boys:
... In the silence of study period I clanked my steel braces against the
iron stanchions of the desk.
"Raymond, will you please try not to make that noise?"
Not angrily, as she would have spoken to another boy. Not leaping up
from her desk and striding down the aisle like a wrathful demon. What was the
matter with her? I thought bitterly. Didn't she know I was doing it on purpose?
I came to school with a pocketful of marbles. I dropped one with a solid
click and let it roll down the floor. I dropped another and another. Miss
Mclntyre left her desk and came to my seat.
Inferior Status Position 31
"Let me have those marbles," she said, holding out her hands for them.
"Give me every one of them."
I took them out of my pocket and poured them into her cupped palms.
"I want to talk to you after class," she said, so quietly I was afraid that the
other children had not heard her.
I was triumphant. I had made her leave her desk and come after me. I was
being kept in after school hke the worst boys in the room. She had taken a
knife away from one boy and several tops from another, and they had never
gotten them back. She wouldn't give me back my marbles, either. Maybe, I
thought, she'd whip me, though I had never heard of any boy actually getting
a whipping.
I sat at my desk after the others marched out and Miss Mclntyre squeezed
sideways into the seat in front of me. She took one of my hands in hers and
held it tenderly while she spoke to me. I was such a smart boy, she said, and
she knew I was a very good boy. I just didn't understand that good, smart boys
didn't do things to disturb the class. . . . While she spoke, tears came into my
eyes. She thought, no doubt, that they were tears of repentance, but they
weren't. They were tears of bitter disappointment and resentment. To make
matters worse, she gave me back my marbles.
That was the time I boasted to the boys next day about Miss Mclntyre's
anger and the severity of her punishment [pp. 48-49].
Sometimes the very performance prompted by the normal ideal itself
suffered. In high school, Raymond tried very hard to walk as others did.
But the more he tried, the more awkward he became:
When I walked through the corridors from one class to another, my braces
clanked loudly on the floor. // / tried to walk less heavily, I became more
noticeably lame. I am sure that none of those girls I passed in the corridor paid
any attention to me, that only a few of them gave me even a passing glance.
But I imagined that every one of them looked at me — not at me but at my
legs — with a shudder of revulsion or, even more terrible to contemplate, a wave
of pity [p. 67, italics added].
Raymond tried to communicate as others did. But the more he tried,
the more he felt like a dunce and a fool:
I am in a classroom. The class is at Latin recitation. We hold our books open
at a certain page and one by one, as the teacher calls our names, we rise and
translate the text, the bidden student taking up where his predecessor left off. I
studied conscientiously the night before; I am thoroughly prepared. Yet, agony
fills me. I am cold with terror, wretched with desperation, stricken by a sense
of impending disaster.
I do what I can to avoid the horror of catastrophe. I try to save myself with
my eyes. But I ask too much of my perceptive wits. My eyes must be on the
teacher's lips whenever she happens to call my name. Even so, shall I know
32 Physical Disability — A Psychological Approach
whether she says Goldman, or Goldsmith, or Gorham, or Bowman? I must be
careful not to rise if it is one of the others whose name has been called.
And how shall I know where to begin, granting that I rise at the correct
time? I know with what page we began; I made certain of it by looking over
the shoulder of the student in front of me. I turn a page whenever the others
turn theirs. But where, on two pages, are they? I watch the reciting student. If
he is behind me, I turn and see his face, but I cannot read Latin from his lips.
If he is in front of me, I watch the back of his head. I can tell whether we are
on the left-hand or right-hand page. The head is turned slightly to the left; the
chin slowly sinks; then suddenly the chin goes up and the head turns a little
to the right. The right-hand page! But what paragraph? What sentence? My
classmate sits down. Look at the teacher! Oh, God, why does she hold down
her head that way, looking at the recitation cards! What did she say? Gorham,
Goldman, Bowman . . . ?
In spite of my desperate efforts I wasn't always successful. There were times
when I didn't rise when the teacher called my name, and sometimes I rose
when she called on someone else. On one occasion I thought she spoke my
name and I got up and began to recite. The class broke into laughter. Behind
me, the boy whose name had been called, had risen and begun to recite before
I got to my feet. When I got up and joined in, like a second alto coming into
a musical round, the teacher had every right to look startled [pp. 67-68].
After his first year in high school, Raymond quit. The normal ideal,
instead of encouraging him toward greater achievements, mocked him into
despair. In grade school, he had achieved considerable success and much
satisfaction in writing, but now his aspirations were destroyed, at least
temporarily, because no matter how much he taxed his motor and per-
ceptual potentialities, he did not fit the pattern of his normal ideal. He
had to learn the hard way that a "crippled boy is essentially the same as
any other boy; that man did not walk and run his way out of beastliness,
but thought his way out; that man is not ashamed because his legs are
relatively crippled as compared with the legs of a deer, and his arms rela-
tively muscleless as compared with the strength of a gorilla" (p. 51).
Raymond stayed out of school for a year, during which time he worked
in his father's furniture store. According to our interpretation, the normal
ideal of being physically like other boys was not the source of the re-
awakening of his ambition. The source was, rather, his gradual recognition
that life is more than physique and that other values are important and
satisfying.
The experiences that contributed to this realization are enlightening:
1. Raymond's initial job assignment — addressing envelopes — was com-
pletely unsatisfying to him. It was boring and yielded little pay. He was
also ashamed, but not of his lameness or of his impaired hearing, for
when he was seated behind a desk where no one spoke to him these
Inferior Status Position 33
characteristics were of little importance. He was ashamed at the thought
of sitting there among women addressing envelopes. What had occurred
here was the emergence of a new standard, a standard that did not define
the necessary physical characteristics of a person but concerned the
value "manliness" as determined by the kind of work he did.
2. Raymond's second job assignment was writing furniture descriptions
for newspaper advertising. When he saw his work in print, something
stirred within him. He dreamed again of authorship and after a while
began to write. His revived ambition was stimulated at home by conversa-
tions about the success of other writers. Stories by a distant relative were
beginning to appear in magazines, and his neighbor, Fannie Hurst, recently
had had several stories published in the Saturday Evening Post. What had
happened here? Again, Raymond became absorbed with new values.
Physique, instead of being the determiner of all of life, began to recede
into the background as he became attracted again to literary pursuits, an
interest that dated from years before.
3. These value changes paved the way for the tremendous discovery
that shame and strain are fed by concealment. Once he realized that
physique was not that important, that other things were far more crucial,
he could confess his deafness for the first time. This he did, to Fannie
Hurst, and experienced a calmness and understanding which taught him
that though he could never get away from deafness he could get along
with it.
In this brief review, we have seen in process several of the value
changes to be analyzed in more detail in Chapter 5. These are: enlarging
the scope of values (i.e., the disability is not the only thing that matters);
subordinating physique (i.e., other values are more important than
physique) and containing disability effects (i.e., the disability does not
affect all situations).
Raymond was now able to return to school, a private high school for
boys. During these years the ideal of normal physique remained relatively
dormant. Because other values and ideas occupied him he foimd life,
unsapped by shame, exciting and rewarding.
Yet the transformation of physique from a comparative value to an
asset value (see pp. 128-133), the value change par excellence that
would strip normal physique of its character as a standard for him, had
not as yet taken place. Raymond was therefore still vulnerable to shame.
Normal physique as an idol still could rear its terrifying head. At gradua-
tion from high school, the old shame returned to Raymond as he saw
the girls in the crowded auditorium and faced the prospect of standing
there on the stage, reciting his poem, with all eyes upon him. Once again
34 Physical Disability — ^A Psychological Approach
he had to come to grips with his position in a world in which normal
physique was an important criterion for personal evaluation.
And in coming to grips again and yet again, Raymond learned several
important lessons: The thought that he could be accepted as he was, even
by girls, began to come to him. During the summer following his gradua-
tion, young and beautiful Edna was willing to sit and talk with him at the
beach even though, because he hadn't dared to walk in her presence, she
thought he couldn't walk at all! With this revelation, the battle raged
furiously within him. Could he, would he, allow others to see him as he
was? The answer fought its way through:
Next afternoon I went down to the beach as usual. I took ofif my trousers
and shoes and waited for the others to arrive. I let them see me as I was, I let
them see my legs, the entire skinny, deformed length of them. Edna, too. I
walked with her down to the sea, naked with a nakedness known only to a
cripple [p. 91].
Raymond also began to realize that his disability could be of real
advantage in some situations. In the college gym course he discovered that
he could chin far more times than anyone else. His upper trunk had been
well developed during the years of exercise in his own gym, and his legs
had little weight to be lifted. The instructor was impressed with his
achievement and called the other members of the class to watch (p. 94).
In thinking over this experience, Raymond achieved even greater in-
sights. He realized that coping with a disability in itself merits recognition
and that what he had sometimes taken as pity was in fact respect for his
striving (see p. 165 for an account of this insight). He also learned that
accomplishment and its reward in admiration depend upon what is ex-
pected of you, not merely upon doing something better than someone else.
These and other experiences and insights led Raymond by the time he
was 30 to his mature formulations bearing upon the problem of normal
standards:
[1.] I did not measure success by what others had accomplished, but by what
it was possible for me to accomplish. Along with shame, I had put envy and
self-pity out of my life forever [p. 101]. I walked anywhere without fear of
being noticed, proud that I could walk at all. I was unconcerned about the
skinniness of my legs. I said, "Pardon me, what did you say? I don't hear very
well," as easily as I might have said, "Pardon me, will you tell me what time
it is? I have no watch with me" [p. 102].
[2.] I can live a normal life although I am not the same as other men [p
115]. . . . while I was not quite the same as other men, I was, nevertheless,
not so very much different [p. 138].
Inferior Status Position 35
In short, a normal physique ceased to be the standard by which Ray-
mond measured and evaluated himself. This is not to say, of course, that
he preferred his imperfect physique to a more adequate one. Rather, he
could appreciate all the good things his body could do for him because
he no longer compared himself with the normal ideal. Instead, the things
he could do became proficiencies. He could walk without braces, and
that was good. A hearing aid improved his hearing, and that was good.
He notes:
... I derived happiness from the queerest sources, things that meant nothing
to other people, mere trivialities such as walking — just walking — down the
street, climbing or descending steps; for who else save a few, could remember
. . . ? [p. 126].
In effect, normal physique had become an asset value for him — i.e., a
good thing to have when present, but not a disturbance when absent (see
Chap. 5).
This value shift, the dethroning of the idol of normal physique, did not,
as some might suppose, remove the source of motivation toward improve-
ment. Raymond continued his four-days-a-week workout at the gym — not
because the normal standard egged him on but because he treasured his
own health and strength. He was able to get married — not because of a
challenge to overcome his inferiority but because he wanted to share his
life with the girl he loved. He applied himself diligently to writing, in
which he achieved considerable success — not because the image of a de-
formed and degraded physique stalked behind him but because the
satisfaction of writing enticed him onward.
And the value shift prepared him for the years of anguish that awaited
him. Within a short time of each other, the two persons closest to him, his
father and his wife, died, and the emptiness that followed was soon to be
capped by a new disability, severe diabetes. But during those years of
black despair the philosophy of life that was to carry him through the
void remained dormant and not dead. He had learned life's lessons well.
Could he not meet the onslaught of diabetes when he had already learned
to get along with the best he had? Could he not meet the pain of bereave-
ment when he had learned to look upon hardship and suffering as part of
life, as meaningful and challenging and not as worthless and humiliating?
The ideal of physical normality had nothing to do with the reawakening
of his will to live, with his savoring again the glory of thinking and feel-
ing and caring and v^Titing. On the contrary, had it played a role, his
despair might well have lasted even longer.
The role of misapplied standards has been explored in other contexts.
To give a brief notion of its generality, the matter of neurosis and sexual
36 Physical Disability — A Psychological Approach
deviation may be mentioned. Adolph Meyer (1948) has stressed unreal-
istic levels of aspiration and lack of self-acceptance as etiologically signifi-
cant in the neuroses. He feels that many persons become emotionally
disturbed because they are unable to "accept their own nature and the
world as it is, and to shape their aims according to their assets" (p. 539).
Newcomb (1950) has discussed sexual deviation, such as homosexuality,
as a function of the degree of rigidity in the prescribed standards for male
and female behavior. Margaret Mead (1949) has considered in similar
terms other facts relating to sex roles. She points out that women who
enter an occupation defined as masculine may do so in order to act as
males or to prove they are as good as males. This drive, being compen-
satory and derivative rather than primary, "will blur their vision and make
clumsy fingers that should be deft as they try to act out the behavior of
the other sex deemed so desirable." Even should they enter such an occu-
pation because of intrinsic interest "they will find themselves handicapped
at every turn by the style that has been set by the other sex" (p. 377).
The parallel case holds true for men.
The same applies to a person with a disability who attempts to abide
immutably by the standards and styles of "normal" performance. Too
often his own performance will suffer, not only because of the psycho-
logical strain of striving to be what he is not, but also because modifica-
tions appropriate to his individual characteristics are forestalled.
Even should the person achieve and surpass "normal" standards, this
in itself, we hold, is no criterion for successful adjustment. Yet individuals
with disabilities who have become outstanding sports figures are held up
as models to be emulated, as examples of persons who have overcome
their handicaps. Thus the statement about a young man who lost a leg
in a railroad accident while still a child: "That he has found the loss no
handicap is evidenced by the fact that he was a collegiate boxing and
fencing champion, captured the men's badminton singles title in his home
town . . ." (Shortley, 1948:i\). We believe, on the contrary, that such a
criterion for adjustment, especially when regarded as the main one, is
psychologically unsound. Competing with normal persons in boxing, and
on the basis of the regular boxing rules may mean precisely that the
person has not adjusted to his disability but has instead been motivated to
achieve in this particular area just to prove that his amputation does not
matter. Actually it does matter, and matters a great deal.
What we are trying to point out is that "acting Hke a normal person" is
not the same as "feeling like a normal person" — i.e., a worthy human
being — and that emphasis on the former may militate against the latter.
This is not to say, however, that persons with disabilities should never
participate in sports designed for the nondisabled, but it is to say that the
way of participation should fit the circumstances of the participants. It
Inferior Status Position 37
does not make sense to cling to the established rules of the game just
because the physically able play that way. Such rigid adherence reminds
us of the immaturity of the young child who in no circumstances can
modify the rules of a game because "rules are rules," whereas older
children are able to do so in agreement with the other participating mem-
bers (Piaget, 1932). All too often, one pays a price for the apparent
success when the motivation is to prove that one is "as good as anybody
else."
Though the overriding potency of "normal behavior" as such is to be
decried, there are important considerations that support abiding by such
standards under certain conditions. First of all, striving toward the normal
ideal may lead to the value change called "containing disability effects,"
in which the effects of disability are seen as restricted rather than perva-
sive (see Chap. 5), by forcing the person to enter activities that he might
otherwise avoid. In so doing, the person may become aware that these
activities are really not precluded at all: "It was great . . . doing the
things you thought you would never do again" (Ohnstad, 1942:151). The
person with a disability, particularly in the case of a recent injury, is
subject to the same spread phenomenon as are the nondisabled majority
(see pp. 118-119). He too will perceive his disability as extending far
beyond the necessary limits, spreading into what could be unaffected
physical and nonphysical areas. In the light of this, the push to act like
anyone else serves the positive function of making certain activities
accessible.
Secondly, it may be necessary to cling to the normal ideal before one
can give it up, to try to be like everyone else before one can find the com-
fort and the reward in being oneself. This may be particularly true in a
society that ill prepares its members for the eventuality of disability and,
on the contrary, fosters the ideal of superman in many phases of its life,
as in industry, sports, etc. We have not found any autobiographies in
which the person was able to sidetrack this phase of the adjustment
process. But it is equally important to note that we have not found in any
autobiography that achieving the normal standards in activities impeded
by disability was the primary basis for adjustment or acceptance of the
disability.
Thirdly, to adhere to certain modes of behavior, though they might not
be as natural where a particular disability is involved, may be recom-
mended when (1) they involve little actual stress and (2) the natural
alternative will be met with social disapproval. An enlightening case in
point is teaching table manners to the blind child. This child should be
cautioned against the tendency to put his nose close to the food or to use
fingers or tongue in an attempt to find out what food is on his plate; it is
easy enough to tell him what is being served. On the other hand, the blind
38 Physical Disability — A Psychological Approach
child should not be discouraged from developing his own special and
sometimes strange means of "space testing," because there is no adequate
"normal" substitution for informing himself about his environment.
"Blind children have been observed . . . clapping their hands, snapping
their fingers, smacking their lips, and clicking or popping their tongues.
All these slightly explosive sharp sounds produce high frequencies and
help the child to know more about his environment, how big and spacious
it is, how far away the walls are, whether it is empty or filled with objects,
etc." (Lowenfeld, 1956:60) J
Finally, adhering to the normal ideal may in some instances be worth
the price of strain and pain, especially if the person does not feel that
such achievement is all-important. To be able to do things in the manner
of others or to look like others may smooth the way in social relations. A
person may be justified in undergoing expensive and painful plastic surgery
for purely cosmetic reasons just because certain aspects of his life will
thereby be ameliorated.
The critical decisions concerning standards and goals must involve a
careful weighing of the possible gains and possible losses. Because the
issues are not clear-cut, because some of them pull in opposite directions,
the matter is not a simple one for mechanical solution. It takes wisdom
based upon accumulated scientific findings and upon the art of sifting the
important from the superficially attractive. In the foregoing discussion,
the dangers of uncritically maintaining normal standards have been
stressed more than certain positive effects of these standards, primarily
because in the total process of adjustment more weight must be given to
the former. Furthermore, in the common sense of adjustment to disability,
the need for reevaluation of standards is generally neglected.
It is certain that, when the implications of maintaining the normal ideal
as a standard are better understood, some of the procedures in current
rehabilitation practice will be modified, for the implications are crucial
to the central problem of what to work toward and how to get there.
Cruickshank has made the point that education for the cerebral palsied
"has permitted feelings of inadequacy as a result of overstress on
normalcy" (1955:334). Meyerson has challenged on the same grounds the
educational philosophy of teaching deaf children. His statement of some
of the issues is so incisive that it bears verbatim recounting:
Everyone will agree that speech and lip-reading are useful tools for the deaf
child. In their finest development they enlarge the life space of the child
tremendously, permit increasingly finer differentiations or growth, and reduce
7 From B. Lowenfeld, Our Blind Children, 1956. Courtesy of Charles C
Thomas, Publisher, Springfield, 111.
Inferior Status Position 39
the communication barriers between the child, his family, and the world. For
reasons that are presently unknown, however, not every deaf child learns to
speak and lip-read. For reasons we can only conjecture, many who do learn,
after 12 to 15 years of continuous drill, later do not use their hard-won skills.
Perhaps they discover the deceit of the implicit promises held out to them that
"if only you learn these skills and behave Uke other people, society will accept
you." Perhaps many discover that their speech and lip-reading are good only
in a limited circle of family and friends. Outside of it they may experience
great difficulty in understanding or being understood. They may discover that
others are amused or annoyed at their voices.
Is a child necessarily a less valuable child if he uses other modalities and
communicates by finger-speUing or pad and pencil? Is nothing else so important
as speech and lip-reading? It is true that in some schools there is a tendency to
establish a status hierarchy of "good" oral pupils and "poorer" manual pupils,
but there is no psychological justification for this. Perhaps parents should
evaluate a school by determining whether its students have anything worth-
while to communicate beyond being able to say "a top, a ball, a fish." Perhaps
they should ask if the children have learned to solve problems by themselves,
whether they have learned to take turns and respect the rights of others, and
whether they have "good" adult power figures with whom they can easily
identify [Meyerson, 7955a.-163-164].8
Lillian Smith (1954) has even insisted that sameness and normality (in
the sense of typicality) have no place in human beings.
In certain quarters the philosophy of rehabilitation is absorbing the view
that instead of normal behavior being the golden guide for "what to do
and how to do it," the abilities and disabilities of the person himself far
more wisely fulfill that function. The counsel given in a small illustrated
booklet to the patients at the Institute for Physical Medicine and Rehabili-
tation on the question of standards of performance should be more
generally applied:
There are hundreds of ways of doing all these things [that make us inde-
pendent]. Maybe with your disability you won't be able to do them the same
way you used to do, but that certainly doesn't mean you can't learn to do them
some other way. And that's why our people are here — to teach you to do
these things the best possible way with your disability [Rusk and Taylor,
1946:S5].^
The account is told of Alice, severely crippled with polio, who learned
to ascend stairs:
s Reprinted by permission from Lee Meyerson, "A Psychology of Impaired
Hearing," in Psychology of Exceptional Children and Youth, to M. Cruick-
shank (ed.). Copyright, 1955, Prentice-Hall, Inc., Englewood Cliffs, N.J.
9 H. A. Rusk and E. J. Taylor, New Hope for the Handicapped. Harper &
Brothers, 1946. By permission.
40 Physical Disability — A Psychological Approach
. . . [Alice] learned to do at least one thing that seems practically impossible
for a person with her limitations: Alice is able to walk upstairs on crutches
without using a handrail. Her technique is to go up the steps backwards
balancing herself on her two crutches as she pulls up her lifeless legs. She
balances herself on her two crutches, pushes down on their handles, thus lifting
the entire weight of her body. As her feet reach the step level, she swings them
backward and catches her heels on the step [Rusk and Taylor, 1946:92].
Had the "normar' way of ascending stairs been Alice's model, her own
*,echniques would probably never have been discovered.
The goals of rehabilitation and education need, therefore, to be evalu-
ated and reevaluated. We need to ask, Are the goals set reachable, and
if so at what price?
Group Identification
As we have seen, "as if" behavior is in many instances a direct expres-
sion of the fervent wish to change one's group identification from the
handicapped group to that of the favored majority. Paradoxically, the
very attempt to hide the disability often prevents the person from feeling
a part of the company of mankind in general. Concealing the disability
does not eradicate it; it still remains in the eyes of the person as the barrier
to his acceptance by the sought-for group. The stigma of disability that
prompts his efforts to cover up at the same time negates his efforts. Not
accepting the truth, he has to pay the consequence of being in the
ambiguous position of the marginal man who belongs fully to no group
(see p. 16). Like the man without a country, he will wander in his search
for acceptance that cannot be his until he accepts himself.
A person threatened by identification with a particular group will also
avoid contact with that group. Thus, the person who wants to forget his
economically meager past will not wish to associate with people "on the
other side of the tracks." Such contact reminds the person of his intolera-
ble conflict resulting from deceit; it reminds him of his guilt and of his
implicit "belongingness" to that group from which he has separated him-
self but whose hurt he well understands. Such contact may also threaten
the person with discovery, for by the mere fact of contiguity he fears that
likeness will be exposed; he may also sense that a person like himself will
see through his mask. A similar psychological situation has been explored
among the Jews (Lewin, 1948: Part III) and among the Nisei (Yatsu-
shiro, 1953) for whom "the Americanization process was so thorough that
in many cases there developed ... a feeling of hostility toward 'things
Japanese,' including frequently their unacculturated immigrant parents"
(p. 205).
I
Inferior Status Position 41
So it is with the person with a disability whose overpowering wish is to
be considered nondisabled. Such a person will "look the other way" at a
social gathering to avoid meeting the eyes of a person visibly disabled. He
is likely to resist the employment of a person with a disability in his own
place of work; he will tend to become hypersensitive to behavior and
mannerisms that earmark a person with a handicap.
The principle of vigilance operates. This principle, formulated by
Bruner and Postman (1948), refers to the tendency of the person to
respond to threatening material with increased alertness in certain cir-
cumstances. It accounts for certain experimental findings on prejudice.
Thus, Allport and Kramer (1946) whose work was verified by Lindzey
and Rogolsky (1950) found that persons high in prejudice not only saw
more faces as being Jewish than those low in prejudice but also were more
accurate in their detection. Though these studies dealt with how majority-
group members perceive minority groups, the explanation of the findings
applies to a minority-group member who has reason to be alerted to
identifying characteristics of his own group. "The question of racial [or
in our context, disability] identity is of small importance to the person
free from prejudice. Yet it is of considerable importance to the bigot [or
to the person threatened by group identification], and for this reason the
bigot apparently learns to observe and interpret both facial features and
expressive behavior so that he can more swiftly spot his 'enemy' " (Allport
and Kramer, 1946:17).
By the same dynamics, a person who wishes to conceal his disability
will notice disability-revealing mannerisms in another person. Moreover,
he is likely to resent those mannerisms that advertise the fact of disability,
for in wishing to conceal his own disability he wishes others to conceal
theirs. Thus it is that the person who is hard of hearing and who strives
to hide this fact will be annoyed at the old woman who cups her hand
behind her ear. Flaunting the disability is a threat to him because it stirs
up the guilt of having scorned his own group membership as well as the
possibility of his own exposure. He may prefer surreptitiously to realize
the other person's secret and to maintain a gentlemen's agreement that
both should play their "as if" roles to having the other person challenge
his pretense by confiding his own. He may even develop an active dislike
for persons who have a disability and will resent being classed with those
who are more severely disabled than himself. One reason why those hard
of hearing were moved to establish separate organizations from the deaf
was just this desire to avoid identification with a more stigmatized group
(Barker et al, 1953:189),
Some of these reactions to group identification are seen in Frances
Warfield's (1948) personal docvmient. It will be recalled that Frances
was terrified lest others should discover her imperfect hearing.
42 Physical Disability — A Psychological Approach
She feared exposure by members of her own group :
... I was terribly afraid of deaf people — they didn't like me; I couldn't talk
loud enough; I was too shy. Moreover, I thought they might be on to my
secret. I thought that, being deaf themselves, perhaps they could tell by looking
at me I didn't always hear [p. 9, italics added].
She felt uncomfortable in the presence of other deaf persons:
Marge Martin gave me the willies. She was very pale, with blond hair and
staring pale-blue eyes. She reminded me a little of Alice Hart, the girl who had
been electrocuted years ago, back home. Marge talked in a flat voice that was
sometimes so faint no one could hear it and sometimes so shrill that people
turned to look at her. That was because she couldn't hear herself accurately,
people said, and therefore couldn't regulate her voice. . . .
Whenever I met . . . [her] on campus I smiled and sang out, "Hello, how
are you?" heartily and hurried past. I didn't want to stop and talk to her if I
could help it. // was embarrassing. You didn't know whether to shout or
mouth words silently, and it gave you a funny feeUng to have her watching
your lips [p. 43, italics added].
She felt her secret would be revealed if she associated with other deaf
persons.
Besides, I didn't want to associate even casually with Marge. Somebody . . .
might get the idea we were alike, that our voices sounded alike, or something
[p. 43, itaUcs added].
She preferred mutual pretense on the part of others who were hard of
hearing.
I went through a series of glubglub part-time maids before I found Poppy, a
large, plush-upholstered Negro with a rich, plushy voice. Then I had to fire
Poppy; I heard her telling the back elevator man he'd ought to speak up, her
young lady didn't hear too good. Poppy was followed by a middle-aged Irish
woman named Vera, and at last I was safe in my own home, thank goodness.
Vera was hard of hearing herself. We played our game together. When Vera
suggested peas for dinner and I ordered cheese instead, she never let on it
wasn't cheese she'd wanted all along. When Ellen Pringle telephoned and
Vera's note on the pad read "Miss Trinket called" I said Mrs. Pringle sounded
exactly like Miss Trinket and, anyhow, people should learn to speak up in this
world [p. 119].
Not only does a person who views his disability as a stigma tend to
feel uncomfortable in the presence of other persons with disabilities but
Inferior Status Position 43
he may also resist association with persons who excel in precisely those
characteristics wherein lie his lacks. For example, a man disturbed by his
own shortness will furtively be interested in the height of a prospective
associate, and should the latter be of notably tall stature, will silently mark
this against him. The person wishing his deficiency to remain obscured
does not welcome a contrast that accentuates it. Thus he is hounded on
both sides; he resists the association of others like him and of others
unlike him. The resistance is a demonstration of the point made by
Homey {1937) that the person who does not believe himself lovable is
imable to love others. Fromm (1939) and others have also asserted that
we should love ourselves, for self-love and the love of others go hand in
hand.
The discussion can be summarized in two propositions: (1) there is a
positive relationship between self -acceptance and acceptance of others;
(2) there is a positive relationship between self -acceptance and felt accept-
ance by others. Experimental support for the first proposition is found in
the studies of Sheerer (1949), Berger (1952) and Fey (1955), the
correlations between measures of self -acceptance and acceptance of others
ranging from r — .36 to r = .69. Evidence for the second proposition is
provided in the work of Fey (1955), who found that subjects with high
self -acceptance tended also to feel accepted by others (r = .71). It is note-
worthy that the degree of self-acceptance bore no relationship to the
degree to which the subjects were actually accepted by the others as
measured by a sociometric device (r = .07).
It is always significant in science to observe, because of lawful relations,
the same psychological phenomena manifested in situations that appear
very different. For this reason it is relevant to note the behavior of mem-
bers of a government housing project who resented having to Uve with
"low-class" people and who for various reasons could not move (Fes-
tinger, 1953). It was observed that severe limitations were placed on the
kinds of contacts they could have with the surroimding community
because they imagined that outsiders would also look down on people
from the project. Thus the project residents, because of their shame over
having to live in the project, remained clearly in a state of relative social
isolation both from members of the project (own group) and from people
in the town (respected group).
We should now like to offer a clinical demonstration of the fact that
acceptance of one's disability is a prerequisite not only for group identifi-
cation with other persons who have disabilities but also with other persons
who are not regarded as disabled. The following sequence captures some
of the phases that Noreen passed through in her gradual acceptance of
kinship toward other persons with disabilities (Linduska, 1947). She had
contracted polio at the age of 24.
44 Physical Disability — A Psychological Approach
At first, even though dangerously ill, she refused to consider the pos-
sibility of polio and insisted that her ailment was "just the flu" (p. 22).
Later in the hospital Noreen vacillated between recognizing and denying
her illness. On the one hand she inquired about the Sister Kenny treat-
ment and combed all the newspapers for every account of polio that was
printed. On the other hand she continued to attribute her paralysis to
various other diagnoses, such as diphtheria, streptococcic sore throat,
malnutrition, and even mental alienation.
Noreen's gradual willingness to recognize herself as a polio patient is
seen when, many months later, as a convalescent who had learned to sit
but not yet to walk, she began writing magazine articles about her ex-
periences with polio. However, she still resisted her new group identi-
fication and avoided answering the letters from her readers who had a
disability, rationalizing that people should not segregate themselves for the
sake of sympathetic company (when actually desiring sympathetic com-
pany is a healthy and honorable motive and need not imply segregation).
When she was asked to become a regular contributor to a monthly maga-
zine for the disabled, she became troubled: "I then realized that I had
slipped into a different group of society and I didn't like it" (p. 129).
The true beginning of a feeling of identification with persons who had
a disability is seen when, during convalescence, Noreen attended a Sister
Kenny rally and felt a sudden kinship with the crippled children on the
platform:
I couldn't ascend the platform, so the nurse helped me to a chair in the front
row. It wasn't bad. I munched the peanuts, and out of the comer of my eye, I
watched the rest of the hall fill. Then the children who were to sit on the plat-
form began to arrive, and a strange kindred feeling arose midway when our
glances met. I saw a little boy with a chromium-plated brace on his back and
his arm stuck out on a shelf extending perpendicularly from the body. They put
him in the front row [p. 162].io
But this feeling of group belongingness was unstable and gave way to
strong resistance against it when the unreality of her present situation
loomed forward in the wake of her reaching out for her past, normal
existence:
. . . Suddenly the peanuts stuck in my mouth, and my whole body surged
with an emotion I could not identify. I began to breathe faster, and I simply
could not decide whether to laugh or cry.
What kind of a crazy, upside-down cockeyed dream was this! crippled
^"Noreen Linduska, My Polio Past, copyright 1947 by Noreen Linduska.
Used by permission of the publishers, Farrar, Straus, and Cudahy, Inc.
Inferior Status Position 45
children! Remember Father's Elks' parties? Remember the Girl Scouts!
Remember the Woman's Clubs! Hey! Just a moment! I don't belong with
crippled children! I'm on the wrong side of this fence! [p. 162].
Soon after, in describing a splash party in the hospital swimming pool,
Noreen was able to feel a real identification with polios:
In our own bathing suits, we polios were rolled off the hospital carts which
conveyed us to the pool ... [p. 167].
It is no accident that Noreen's glimmering feelings of kinship with the
minority group were concurrent with her awareness that crippling was an
adjustable state, one that still provided tremendous scope for meaningful
activity. During the rally, Noreen was lost in thought:
Who said that cripples are unfortunate? Do they, or do you? . . . Polio is
not sad — it is just darned inconvenient . . . [pp. 164—165].
The morning before the rally, Noreen had visited the children's polio
ward and realized that the world had room for differences:
. . . Here I was in a roomful of the tiniest "victims" as the newspapers
called them. . . .
In this room were the little shoes that would be lifted into the Orthopedic
School Bus that used to pass our house every morning as I was running down
the front stairs to catch the 7:45 "L." These little shoes wouldn't fit into roller
skates or skis or be exchanged for soldiers' boots. These would know a different
world than that of being center-fielder on the local dry goods baseball team. It
wasn't sad — it was simply different, and I knew undramatically that there is a
place all picked out in this world for every one of those baby faces [p. 157].
It is equally significant that as Noreen began to appreciate the adjusta-
ble side of crippling, there were major shifts within her system of values:
moral imperfection became far more important and deplorable than physi-
cal disability:
Why and when had physical perfection become so important, when mental
imperfection, more easily remedied, went along so unnoticed. Little crippled
boys were given sympathy because they could not walk, but how about the
little boys who had never been taught to read or write. How about the minds
of the children who lived in the same room where the adults in the family
slept. Would their minds be crippled? Would somebody pity them if they
could run very fast but didn't believe in the future of honesty? Would they be
pitied if they lacked whatever it takes to love the dark-skinned children whom
they had gone on strike to ban from their high schoo'*? Would they be pitied
46 Physical Disability — A Psychological Approach
if they grew up to think that sex was the only thing in Hfe worth working for,
and that to be a pin-up girl in a movie studio was the greatest honor a woman
could achieve? [pp. 158-159].
This is in sharp contrast to her prepolio outlook where physique and
good health had been key criteria for status judgments:
... I had belonged to a generation of laughers. My "crowd" was gay and
alert. We liked everything new, and if it wasn't new enough, we would invent
something that was! I liked to move about all the time. I was thrilled with
tennis and volley ball and swimming — and I adored dancing. I had made a
hobby of the Russian Ballet ever since I had written an eighth grade term-paper
about it. I had secretly been vain about my grace and I loved to remember the
man who tried to persuade me to become a part of his adagio team. I had
always wanted to be a dancer, but not that kind. The fact that my parents did
not approve of dancing as a career did not keep it from being a secret ambition.
Good health was the most important thing in the world, and we even un-
consciously scoffed at people with too-frequent sniffles [pp. 176-177].
Noreen was further along the path of adjustment than was Jay, a young
man also convalescing from polio. He was greatly troubled by the antici-
pated pitying attitudes of people outside the hospital. Noreen was better
able to take this prospect objectively and to concern herself with its
coping aspects. Her adjustment was strengthened by a reevaluation of the
meaning of life involving a reconsideration of the relative importance of
significant values.
Jay vividly described the deep struggle against being pushed into an
alien group, that of the handicapped. His resistance against being dis-
located from his former position was so great that he could not begin to
see what his new circumstances had to offer. As long as he felt that he
did not belong to the group with a disability, he would continue to feel
that he did not belong to the "other half" either. The price for refusal to
acknowledge membership in one's own group is great:
. . . When you are healthy all your life, and suddenly in the best years of
it, you slip into the other kind — you are naturally unhappy. You are out of
your element, a fish out of water. You find yourself where you do not belong.
You remember how the other half lives, but you can't live with it. You won't
concede your former position — you won't even turn your head to see how
comfortable the new category might be. You liked the old places, and there you
want to stay — there you don't belong any more, but there you want to stay — so
you do — miserably! [p. 194].
Physique, which was a central value for Jay, provided the foundation
for his powerful resistance against belonging to the disabled group. For
Inferior Status Position 47
Noreen, physique was becoming a relatively superficial characteristic,
other values being of far greater importance. Consequently, she was now
able more comfortably to accept her disability with the result that she
was also able more comfortably to feel a part of the nonhandicapped
group as well. In answering Jay, she said:
. . . "When you once belong to a group, you always belong. You belong to
it because of a lot of reasons you have nothing to do with — race, religion,
position, education, inherited traits and talents. Those things are not physical,
but they make you belong someplace. Sometimes these uncontrollable factors
combine and people of unlike religions or talents make up a group — but some-
where there is a common, compatible factor. Just because you can't hop off a
chair or go running down some stairs doesn't mean that you belong to a dif-
ferent group — the common factors are never that shallow" [p. 194].
To sum up, the preceding analysis revolved around the following points:
1. During the initial phase of her illness, Noreen refused with all the
psychological maneuvers she could muster to accept the fact of her
disability.
2. Her prepolio values provided a strong foundation for this resistance.
Health had been all-important, with physical skills and grace in close
second position.
3. But the facts of her illness were unrelenting.
4. And something was being done about her condition. She was massaged,
hot-packed, etc.
5. Gradually she became less preoccupied with the threatening, succumb-
ing aspects of disabiUty and more involved with ideas of coping
with it.
6. Concurrently, changes occurred within her value system. Moral and
personality values became more important than physique, which was
but a shallow characteristic.
7. These changes helped Noreen find her locus within the group with
disabilities and consequently also within the ranks of the normal
majority.
But the pendulum must not swing the other way. To accept one's dis-
ability and oneself as a person with a disability by no means implies an
all-absorbing interest in disability-connected problems. Too much pre-
occupation may be as much a sign of maladjustment as ostensibly too
little. Generalizing to all group memberships, Lewin correctly points out:
"If an individual's membership in any one group, e.g., the Jews, is of
dominant interest to those around him in all situations, or a dominant
value for him in all situations then he is living in an unhealthy totalitarian
48 Physical Disability — A Psychological Approach
social setting from the point of view of group dynamics, no matter
whether this dominating membership is his family, his race, his religion,
or his nation" [or, we add, his disability] (Lippitt, 1945:26).
But accepting one's disability and oneself as a person with a disability
does imply a certain feeling of kinship with others who have the disability,
a feeling of knowing such a person a little even though he is a stranger, in
the same way that meeting an American abroad makes for an immediate
tie, albeit a temporary one. This hypothesis may be integrated within
Heider's {1958) theory which relates sentiments to unit formation (see
pp. 262-263). Accepting one's disability allows the factor of similarity to
bring about unhampered the formation of a group, which in turn arouses
a positive feeling toward the other person. This phenomenon is seen in
the personal experience of Louise Baker (1946), an amputee:
I have met a great many crippled people since then and some of them have
developed into real friends. Even the most casual contacts, however, have been
rewarding. One-Ieggedness is a common ground on which individuals of vast
difference in background can meet and communicate. I have had fascinating
conversations with handicapped persons whose lives were so divergent from my
own that in the normal course of a two-legged life, I never even would have
crossed their pathways.
A jolly drunk who sold newspapers on a city corner and who happened to
wear a peg leg, gave me a full, though perhaps slightly alcohol-flavored, account
of himself one day while I waited for a bus. Similarly, I've learned all about
the private lives of a taxi driver, an ex-policeman, a sculptor, a factory worker
out on parole from a woman's reformatory, a little one-armed Negro orphan,
a Japanese fruit peddler, an architect, etc., etc. We speak to each other. We
flaunt our fraternity badges. Whatever our limping walks in life we are all
people of parts — missing. We stand on common ground. We may remain
transients; we usually do. We meet; we pass on; but we enrich each other in
the passing [p. 156].ii
Accepting one's disability and oneself as a person with a disability does
mean that belonging only to the majority is not all-important, for in
belonging to the minority as well one belongs to humanity, a group that
knows no majority-minority boundaries.
The Eclipse of Behavior Possibilifies
The insecurity of the person who tries to forget and conceal his dis-
ability is yet further increased because he does not allow himself to
clarify what he can and cannot do. We have seen (pp. 21-24) how
" Reprinted by permission from Out on a Limh by T ouise Baker, published
by McGraw-Hill Book Company, Inc. Copyright 1946 by Louise Baker.
Inferior Status Position 49
Frances bluffed her way through all kinds of social occasions, instead of
asking for more light in order to lip-read, or for someone to speak louder
or to repeat (Warfield, 1948). Frances figured out elaborate techniques to
cope with "dinner lulls," intermissions at concerts, football games, dances,
and so on, in order to protect her secret. But they served only to make her
more uncertain, and in turn more cautious, and in turn more uncertain.
Thus, Frances had it down pat that at a dinner party she should (1) sit
next to someone with a strong voice; (2) choke, cough, or get hiccups, if
someone asked her a direct question; (3) take hold of the conversation
herself, ask someone to tell a story she had already heard, ask questions
the answers to which she already knew (Warfield, 1948:36). But what if
she were placed next to a mumbler? What if, after her coughing, the
person persisted in asking questions? What if? The uncertainty and panic
snowball. Behavior resulting from new and uncertain situations follows
(see Chap. 4).
The person does not allow himself to clarify his behavior possibilities
because, in order to do so, he must first be able to acknowledge, "this is
my limitation. . . ." Only then will he realistically be able to study the
requirements of different situations toward his more able functioning in
them. Only then will demarcation between what he can and cannot do
become more sharply defined. Only then will he realize that confidence in
the self which is essential to the adequate meeting of new situations that
inevitably present themselves.
Compensation as Indemnity
Overcoming of inferiority is also sought by way of compensation.
Compensation has been defined as "the individual's attempt to make up
for an undesirable trait and the consequent discomfort by emphasizing or
exaggerating a desirable trait" (Maslow and Mittlemann, 1951:515).
In order to avoid semantic confusion, let it be noted that compensation is
sometimes used in a fundamentally different meaning. Sommers (1944),
for instance, applies the designation "compensatory reaction" to those
individuals who recognize and accept the limitations of their disability and
concentrate on what they can do. It is in the former sense that we shall
use the term "compensation" — i.e., as an indemnity, a way to "make up
for" a shortcoming in order to redeem oneself.
The concept of compensation was given a prominent place in adjust-
ment theory at the instigation of Alfred Adler {1917a, b), who felt that
organic or constitutional inferiority was basic to man's striving for adapta-
tion to the world in which he lives. In compensating for his inferiority,
the person may either be led to constructive achievement or to a neurotic
power drive.
50 Physical Disability — A Psychological Approach
That compensation occurs cannot be denied, but to consider it the
spring of all or even most motivation is questionable. Also questionable is
the view that compensation, as a prodder of achievement, is a way toward
mental health. These issues are especially germane to the psychology
of disability because of the readiness with which all behavior is linked
with the disability. Thus, accomplishment tends to be seen as compen-
satory, particularly when the achiever has an obvious disability.
Cutsforth (1948), a clinical psychologist who is blind, deplores the
approval that educators and social agencies for the blind place upon
compensation: "The attempt to compensate for the feelings of inadequacy
drives the individual oftimes to the achievement of successes, but never
to personality adjustment" (p. 67). A person with a physical limitation
has, in fact, nothing "to make up for" — that is, unless he feels inferior
because of it. The following admonition captures the essential devaluating
presupposition underlying the adjustment theory of compensation: In
order not to be especially bad, the person with a disability (or any
minority-group member) must be especially good. The theory of com-
pensation that includes "making up for" as part of its dynamics is actually
a theory of shame and guilt.
The fact that a disability imposes limitations in certain situations does
not mean, perforce, that the person has to sing better, or write better, or
do something else better. It means only that he, like everyone else, has to
engage in and pursue those activities which he can do and finds rewarding.
He will not join the track team, because there is no sport where there is
no challenge. But he may become a radio ham, not because he must
"make up for" his limp, but because mechanical and electrical matters
interest him. Had he been sound of limb, it is possible that his mechanical
interests might have directed him toward piloting an airplane. But this
does not mean that being a radio ham is second choice to piloting — not
necessarily. Now that he has explored radio, he may find it more challeng-
ing than piloting, even if the choice were his to make. Moreover, his
initial move toward radio need not have been primed by compensatory
forces. When a person is unsuitable for one undertaking, he may seek
another and pursue it because the experience is satisfying rather than
compensating. The person who cannot become a doctor because of limited
financial means chooses instead to become a biologist, not necessarily
because he is compensating, but because limited financial resources is but
one among other important considerations. All major decisions take into
account a vast array of factors in order to lead to the best choice. The
final decision is not compensatory just because it has included considera-
tions of limitations.
Actually, if the prime motivation to be a good radio ham continued to
be compensatory, the person's full satisfaction of achievement would be
Inferior S+afus Position 51
spoiled by the interminable fermentation of inferiority feelings over the
fact that he is a cripple. His achievements, no matter how great, would
not alter the fact of his disability, and as long as he felt that this fact had
to be compensated for, so long would he continue to suffer the apology for
himself. Byron, the great British poet, Talleyrand, the great French states-
man— each was bom with a club foot. Byron evidently showed as much
ambition to excel in violent exercises as the most robust youth of the
school. Though both rose to the heights of world fame, it is reported
that neither could ever forget for a moment that he was lame, and both
suffered the ignominy of attempts at dissimulation and feigning (Hentig,
1948a:15-ie).
In only one sense would vve propose that compensation as a principle
of mental hygiene has anything to recommend it. The driving force that
pushes a person to new pursuits may produce major alterations in the
individual's system of values. The new areas may reveal satisfactions and
values which become more important than the old ones that led the
person to compensate. A person who paints because he limps may dis-
cover that art is a significant value too, that a person's worth need not
arbitrarily be connected with his physique.
EFFECTS ON PERSONALITY
Opinion and Research Findings
One might suppose that a stigmatizing, underprivileged social position
would predispose the individual toward feeling inferior as a person. As a
matter of fact, feelings of inferiority are mentioned with considerable
frequency by experts and laymen alike as characterizing disabled groups.
A study of the expert opinion of professional workers with the handi-
capped revealed that feelings of inferiority (with a frequency of about
25 percent) headed the list of behavior characteristics mentioned by 26
authors in general articles about the handicapped (Barker et al., 1946:71^.
A study of the opinion of high school students revealed that when the
stimulus subject was represented as crippled he was rated as feeling more
inferior than when he was represented as able-bodied (Ray, 1946) . Specifi-
cally, high school students were presented with six photographs of college
boys to be placed in rank order according to a number of behavior and
personality characteristics. One of the college boys was photographed
sitting in a wheel chair and this picture was presented to half of the
subjects; to the other half, the same picture was presented with the wheel
chair blocked out. When depicted as crippled as compared to able-bodied,
the stimulus was judged to be more conscientious, to feel more inferior, to
be a better friend, to get better grades, to be more even-tempered, to be a
52 Physical Disability — A Psychological Approach
better class president, to be more religious, to like parties less, and to be
more unhappy.
However, when we turn to the research literature on the actual feelings
of persons with disabilities, a far less clear-cut picture is found. In some
studies, the disabled groups earned scores indicative of greater self-respect
than their "normal" controls. For example, the postpoliomyelitis cases in
Seidenf eld's (1948a) study showed a greater sense of personal worth on
a personality test than the groups on which the test was standardized. And
in Arluck's (1941) study, both the cardiac and the epileptic subjects
more often felt superior to most children in respect to attitudes, feelings,
and interests than did their normal controls, as measured by a self -rating
scale.
In other studies no relationship was found between specific physical
characteristics and inferiority feelings. Sommers' (1944) blind adoles-
cents, for example, came out just as high on sense of personal worth as
the norms for the standardization population. And negligible correlations
were found between inferiority feelings and height or weight of men and
women in another study (Faterson, as reported in Paterson, 1930).
On the other hand, studies do exist that show a relationship, albeit a low
one, between feelings of inferiority and physical defect. In Arluck's
(1941) study, the epileptic subjects, but not the cardiac subjects, tended
to feel that they were inferior in respect to their behavior, though not in
respect to their feelings, more often than did the normal subjects. The
hospitalized tuberculous but not the hospitalized amputees in a study by
Shelsky (1957) tended to be more self-rejecting than the control subjects
who were also hospitalized but for minor illnesses. The findings in this
case were based on a self-rating scale utilizing an adjective check list. In
still another study by Faterson (1931), the Minnesota Rating Scale for
measuring inferiority attitudes was administered to a group of entering
university students and the resulting scores were correlated with degree of
physical defect as determined from each student's medical report. A
physical-defect score was obtained by giving one point for each physical
defect reported on the medical blank, such defects being included as fallen
arches, menstrual disorders, heart murmurs, poor posture, nasal obstruc-
tion, orthopedic defects, diseased tonsils, insomnia, tiredness, etc. The
correlations between inferiority feelings and physical defect for men and
for women were low (under .25) but positive. (Note that the physical-
defect score included deviations such as insomnia and tiredness which
might easily have a large psychosomatic component.)
No matter how the studies are grouped, the data cannot be ordered so
that scores of inferiority are in any systematic way related to disability or
to such aspects of disability as type, duration, or degree.
Inferior Status Position 53
Oversimplified Connection Between Disability and Inferiority Feelings
To attempt a clarification of the preceding problem, several considera-
tions need to be taken into account. First of all, disability is not the only
characteristic that places a person in an inferior status position. Under-
privileged minority status touches those of particular races and religion,
of low socioeconomic level, and of slower mental development. Even
children are placed in the psychological position of inferior status, and
women too in some respects. In short, all of us have within us the ex-
perience of being looked down upon as individuals or as part of a larger
group.
But, the protest might be made, a person with a disability has the stigma
of a disability superimposed on whatever other depreciating characteristic
he might have; he has a greater load of inferior status to bear and a more
persistent one. Ought not this fact lead to more pronounced feelings of
inferiority? Evidently not. And the reason is an important one. Psycho-
logical processes do not add up in a simple way.
For clarification, let us consider the relationship between degree of
disability and adjustment. One might assume that the greater a person's
disability, the more difficult it is for him to accept it or to achieve good
adjustment. But the facts provoke serious question of this. Though some
studies (Brunschwig, 1936; Kammerer, 1940; Landis and BoUes, 1942)
have shown a relationship between degree of disability and poor adjust-
ment, other studies (Springer, 1938; Donofrio, 1948; Tracht, 1946) have
shown no relationship, and still others (Macgregor et al., 1953:10; Miller,
1958) have shown the reverse relationship.
To explain these inconsistencies, it may be postulated that a person
with a mild disability may, because he is almost normal, have a greater
push to hide and deny his disability, thereby thwarting his own adjust-
ment, whereas a person whose disability is so severe as to be undeniable
has little recourse but to grapple with the problem of accepting himself
as a person with a disability. Support for this hypothesis may be drawn
from the point made by Heider (1958) that a near approach to what we
desire seems to make its attainment more possible, and from Dembo's
(1931) observations in experiments on anger that the subjects were more
disturbed when they almost succeeded in the task (throwing rings on a
peg) than when the failure was more clear-cut. The observation has also
been made that the child with cerebral palsy who has a mild handicap
appears to have more severe adjustment problems arising from disturbed
parent-child relationships than does the child with a severe cerebral palsy
involvement (Miller, 1958). On the other hand it may also be postulated
that a mild disability, by imposing fewer frustrations owing to the barrier
of physical limitations, makes adjustment easier. Doubtless there are
54 Physical Disability — A Psychological Approach
other factors associated with degree of disabUity, some favoring and some
hindering good adjustment, the resultant effect being quite removed from
the objective fact of severity. Notice that we have moved from the physi-
cal fact of degree of disabiHty to psychological concepts, such as need to
hide the disabUity, perception of probability of goal attainment, and frus-
tration, in order to account for the associated personality and psychologi-
cal behavior. Such psychological concepts are known as intervening
variables and are necessary for the understanding of somatopsychological
problems (see pp. 377-380).
By like reasoning, we cannot say that frequency or intensity of social
devaluation is related in a direct or one-to-one way to personal feelings
of inferiority. With increase in social devaluation may come an increased
need for a new look into one's values, which, as an important first step in
the process of adjustment, may do much to counteract the destructive
power of inferior social status.
Furthermore, inferior status is not the only psychological situation in
which a person with a disability is placed. At times he may be looked up
to and may even enjoy an exalted position (see Chap. 3). The majority
group may sometimes bestow genuine commendation, as when the person
is acknowledged who achieves in spite of his disability, and certainly
respect, encouragement, and acceptance from family members and close
friends are not infrequent. That salutary status and acceptance by others
are not foreign to members of minority groups is undoubtedly an im-^
portant prophylactic against the deluge of feelings of worthlessness.
In an important study by Langdon and Stout (1951) on well-adjusted
children, it was discovered that despite tremendous differences in the
background and physical characteristics of these children, many of which
could be considered as social or physical handicaps, there was one out-
standing similarity: the children were loved by their parents in an atmos-
phere of warm though not necessarily demonstrative acceptance. Of the
261 well-adjusted children, some wore glasses, one used a hearing aid, a
few were described as overweight, some underweight, several were left-
handed. One was said to have a spastic condition, another a heart lesion,
another to be diabetic. The children were oldest, youngest, in the middle.
Some were from poor homes and some from middle-class homes and
higher. Several children came from one-parent families through divorce,
separation, or death. There were children of mixed religious beliefs. There
was such a diversity of discipline procedures as one can hardly imagine,
ranging all the way from 'They do what I say or else" to "We want them
to want to do what is right." Yet all these children were well adjusted!
And all the parents, without a single exception, expressed in some way the
following thoughts as being most important of all: Loving them and letting
them know it, thinking of them as people and treating them so, appreciat-
Inferior Status Position 55
ing what they do and trusting them and telling them so, and above all
letting them know they are wanted. This study is important in showing
that conditions commonly accepted as being deleterious to personality
development do not necessarily bend the twig into a deformed tree; the
tree may flower and prosper because of deeper psychological soil made
rich by growth-promoting interpersonal relationships.
The thesis presented here does differ from Alfred Adler's {1917b)
theory, which holds that ". . . the possession of definitely inferior organs
is reflected upon the psyche — and in such a way as to lower the self-
esteem, to raise the child's psychological uncertainty. But it is just out of
this lowered self-esteem that there arises the struggle for self-assertion
. . . the predisposed child in his sense of inferiority selects out of his
psychic resources expedients for the raising of his own value . . . among
which may be noted as occupying the most prominent places those of a
neurotic and psychotic character" (p. 3). The Adlerian doctrine would
lead one to expect a high incidence of neurotic and psychotic tendencies
in individuals with a physical disability and specifically of marked feelings
of inferiority. The available objective evidence, however, supports none of
these expectations and forces one to the conclusion that there has been
a gross oversimplification of the connection between physical impair-
ment and maladjustment.
Moreover, even should inferiority feelings in an individual case history
be associated with defective physique, we must in order to understand
and evaluate those feelings ". . , deal with the individual in relation to and
as part of the family, and with the family in relation to and as part of the
individual's cultural environment" (Sommers, 1944:98). As Allen and
Pearson (1928) have pointed out, "When the relationship between the
child and its parents and its effect on the development of the former's
personality is studied, it becomes evident that this feeling of inferiority has
causes other than the physical defect, although these causes are associated
with and conditioned by it" (p. 234). Sommers' (1944) intensive study
of blind adolescents clearly reveals that the feelings of the individual with
regard to his own inferiority, incompetence, uncertainty, and the manner
in which he accepts his defect are conditioned principally by the attitudes
of those around him, especially his parents.
Our position must be further clarified on one point. It does not assert
that physical disability plays no role at all in the development of inferiority
feelings or other problems. It does imply, however, that the objective fact
of disability is an extraordinarily poor criterion for judging which indi-
vidual is unduly beset by self-abnegation and which individual is not, and
that the common association between inferiority feelings and atypical
physique is a gross oversimplification unwarranted by the facts.
Indeed, physical disability, through social derogation, does produce
56 Physical Disability — A Psychological Approach
psychological problems. Some of these have already been reviewed in
this chapter. And the problems are not easy to solve, for they are weighted
with frustration and hurt and sorrow and their inherent conflicts pull the
person in different directions. But persons with disabilities do solve them,
evidently about as well (or as poorly) as do the nondisabled who are also
faced with the same psychological problems though their specific content
may differ in some respects. Some factors important in the process of
solving the difficulties stemming from a stigmatizing personal character-
istic are discussed in Chap. 5.
Thus far we have been concerned with efforts to escape the stigmatizing
effects of disability, efforts that are first attempts and often persistent but
not soundly adjustive, for they function to sidetrack negative attitudes
associated with disability rather than to overcome them. The discussion
dealt with forgetting, concealing, idolizing normal standards, group
identification, the eclipse of behavior possibilities, and compensation as
indemnity. It was seen that these phenomena were prompted and guided
by a basic rejection of the disability when it is seen as a devaluating
characteristic which makes of one an inferior person. At the same time,
the person has a need to accept his disability; in spite of all, he would
like to feel comfortable with himself as a person with a disability, and to
have others accept him as such. The undercurrents of these feelings, long
repressed, may be stirred into consciousness by the gradual recognition
that pretense produces nothing but repeated failure, shame, guilt, and
estrangement from oneself and others. Pretense gradually becomes recog-
nized for what it is, an insult added to an injury. It is then that efforts to
accept the disability become more clearly the honorable and realistic
method of choice.
The value changes implied in these efforts are discussed at length in
Chap. 5. In the following chapter, attention will be given to the fact that,
along with inferior status, disability may under certain conditions also
bring with it a position of respect. It is well that we examine these condi-
tions, for within them lie important clues for aiding adjustment to dis-
ability.
Chapter ^
Salutary Status Position
Favorable, publicly expressed attitudes toward persons with
atypical physiques are not infrequent. In one study (Mussen and Barker,
1944), students were asked to rate cripples in general on 24 personality
traits. The median ratings fell nearest the following descriptive phrases:
Conscientiousness: Tries harder than most
Self-reliance: Tendency to have more than average degree
Kindness: More than average
Emotional restraint: Tendency to be reserved; seldom lets the world know
his feelings
Persistence: Quite persistent; gives up only after definite proof of impossi-
bility
Mental alertness: Intelligent; more alert than average
Originality: Tendency to be more creative than average
Religiousness: Tendency to be more religious than most people
Impulsiveness: Inclined to ponder possible results of behavior
Unselfishness: Marked tendency to be unselfish; generous, altruistic
Friendliness: Average
Trustworthiness : Average
Disposition: Average; for the most part moderately cheerful
Tolerance: Average
Courage: Average
Self-pity: Average
Social poise and tact: Average ability and interest in getting along with
others
Vitality: Average amount of vitality, energy, pep
Self-confidence: Average
Submissiveness: Average amount of ascendance and submission
Realism: Given to reverie occasionally
Aggressiveness: Tendency to be mild; gentle in approach to others
Social adaptability: Finds it somewhat difficult to adjust to new situations
Sensitiveness: More sensitive than average
Ray's {1946) data (detailed on p. 51) support the preceding study in
showing that publicly expressed attitudes toward cripples are frequently
57
58 Physical Disability — A Psychological Approach
favorable. Covert attitudes, of course, may in some if not many of these
instances still remain negative.
When the subjects of Strong's (1931) study were asked whether they
liked, disliked, or were indifferent to persons with a variety of physical
characteristics, the most common response was "indifferent." Cripples and
blind persons were more frequently checked as being liked than disliked,
whereas the reverse was true for deaf-mutes. The following percentages
represent the responses of 2340 professional men and businessmen be-
tween the ages of 20 and 60.
Liking
Disliking
Indiffer
Sick people
22%
28%
50%
Very old people
45
1 1
44
Cripples
29
19
52
Side-show freaks
4
77
19
People with gold teeth
4
46
50
People with protrud'
ng jaws
6
42
52
People with hooked
noses
4
38
58
Blind people
25
16
59
Deaf-mutes
16
25
59
These percentages may be compared with the following:
People who borrow things 3% 77% 20%
Negroes 13 32 55
Socialists 8 4! 51
Athletic men 74 I 25
Conservatives 50 12 38
The evidence seems clear that publicly expressed attitudes toward
persons with physical disabilities for the most part are not unfavorable,
are frequently mildly positive, and may even indicate respect. Yet positive
feelings toward persons with disabilities have been given little attention.
Positive attitudes in general are more apt to go unnoticed and unnamed
because they do not disturb our sense of well-being, of what "ought" to be.
So it is that the nomenclature of maladjustment is much richer and more
differentiated than that concerning good adjustment. The list of pathology
extends long and wide, whereas normal adjustment is modestly described
under the relatively undifferentiated classification, normal adjustment. We
shall find, however, that once we trouble ourselves about the untroubling
positive status aspects of disability, their still waters run as deep as th'!
turbulence of inferiority.
Salutary Status Position 59
COPING VS. SUCCUMBING
A woman, in musing about injured war veterans, remarked, "When I
thought of the courage it took to ignore those handicaps, I felt humble.
I felt that anyone who overcomes a handicap like that wins an added
amount of respect from everyone" (Dembo, Leviton, Wright, 1956:24).
In contrast, others in thinking of severe disabilities feel, "It wouldn't be
worthwhile to live." "I'd go into hiding and not show my face for the
rest of my life" (Dembo, Leviton, Wright, 1956:24).
What are some of the immediately underlying differences between these
two points of view? In the first instance, the person, although appreciating
the seriousness of the disability, focused on the adjustable or coping
aspects. She saw the difficulties associated with a disability as something
that could be faced in some way or overcome. Those who voiced the
second kind of comment saw the difficulties as a quagmire through which
there was no path. Perhaps one doesn't even seek a path, for one is so
consumed with the suffering of the disabled state that one is dragged down
by despair. The difficulties are in command and one succumbs to them.
One's orientation toward coping with or succumbing to difficulties has
contrasting effects on the evaluation of a person with a disability. When
the person with a disabihty is coping with his problems and the black side
of things is held in check, he is placed higher on the scale of adjustment
than in the reverse situation. A person with a disability who is seen to
make the most of what he has, to arrange his life in accordance with his
abilities, is respected and even admired. Further positive attitudes may
also be differentiated, such as feeling that the person has courage, or
ambition, or stamina, etc. Even should the person die as the result of his
injury, the fact that he "put up a good fight" — i.e., that he was occupied
with coping with his problems — makes him a person of strength and
dignity. In contrast, when preoccupation with the undermining or suc-
cumbing features of the situation prevails, the person tends to be de-
valuated. His situation may be looked upon with horror and even derision,
and he may be pitied or even contemptuously disregarded.
Of course, concentrating on the coping possibilities does not imply
glossing over the difficulties themselves. Disregarding difficulties could
lead only to unrealistic behavior on the part of the person with the dis-
ability or, if others should ignore his difficulties, it would make him feel
that they are taking his situation lightly. Actually, coping means coping
with the difficulties rather than managing because of blissful ignorance or
pretense. Indeed, the difficulties must be realistically appraised if con-
tinued failure and discouragement, the most effective impetus to succumb-
ing forces, are to be avoided.
60 Physical Disability — A Psychological Approach
Coping, even when half-hearted, may provide the spark for the adjust-
tive change designated as "enlarging the scope of values" in the case of
what has been called all-inclusive suffering (see pp. 108-115). Coping
may also provide the opportunity for "containing disability affects" (see pp.
118-128), for it leads to new learnings and solutions that overcome dif-
ficulties. The person who becomes blind, for example, must learn to go
from his bedroom to the kitchen, and in trying discovers that visual cues
are not the only stimuli the world has to offer. "Then you perceive sud-
denly that there is order and reason and communication within the vast
darkness which had seemed only chaos" (Ohnstad, 1942:42).^ The way
Karsten Ohnstad relearned to write soon after he became blind illustrates
well how coping is the true mother of invention. He became impatient
with having to depend on the nurses for doing his writing, and after
trying unsuccessfully to produce a legible product on his own, he dis-
covered that he needed something to hold his paper steady and to keep the
lines straight across the page:
... I found a medical-chart holder — a flat piece of metal with rubber-tipped
clamps at the top. The rubber clamps held the paper firmly in place. As a guide
for making a straight line, I laid an envelope across the sheet and folded the
left end under the chart, so that it could slide up and down along the edge
without becoming crooked. A rubber band slipped around the entire chart held
the envelope in place at whatever point I pushed it. It worked! When I made a
^ or an / or any letter that dropped below the line, I lifted the edge of the
envelope until I had made the loop and then dropped it again. The lines were
no longer run together. Completing a line at the right-hand side of the sheet, I
pulled the envelope downward the approximate distance of the line, and there
it remained, held fast by the rubber band. I handed the letter to a nurse and
glowed with the pride of accomplishment as she read it word for word rapidly
and without hesitation [Ohnstad, 1942:48-49].
Psychologists increasingly are concerning themselves with the positive
strivings in man, with the factors that lead him to face and cope con-
structively with his problems. Among the investigators who have recently
given particular attention to this emphasis are L. Murphy (1956), in her
research with children, and Maslow (1954) and Rogers (1951) in their
work with adults. The emphasis was explicitly recorded in the proceedings
of an Institute on Psychology and Rehabilitation (Wright, 1959). Among
the 12 principles and assumptions defining rehabilitation listed therein are
included (1) the importance of stressing the "assets of the person," his
stabilizing and maturity inducing characteristics, and (2) the necessity of
1 Karsten Ohnstad, The World at My Fingertips, Indianapolis, The Bobbs-
Merrill Company, 1942. By permission.
Salutary Status Position 61
dealing v/ith "reality factors," those difficulties within the actual social and
physical environment with which the person with a disability has to cope.
In summary, coping serves the person in various ways. As a value in
itself, it enhances his status. It also makes possible adjustive changes in the
outlook of the person with respect to his disability.
Attractions and Aversions as Expressions of Coping-Succumbing
One type of affect aroused by the perception of coping or succumbing
associations — namely, the aesthetic reaction to disability-connected sym-
bols— can be taken as typical and discussed at length. Reaction to the sight
of blood, an exposed stump, braces and crutches, etc., is sometimes
matter-of-fact and even positive, sometimes strongly antipathetic. One
might, for example, turn away from the sight of blood when it signifies a
crushing accident, suffering, and pain but be quite calm about it when it
connotes the life-saving material for the blood bank. One might be
bothered by the sight of a stump and consider its exposure indecent, or
see it as well healed and ready for a prosthesis.
The same holds true for aesthetic reactions to prosthetic devices. During
Harold Russell's {1949) initial reaction to his handlessness, he thought
of hooks in terms of their devastating implications — as "claws" and
"flippers," "hollow in sound." An old-time amputee, on the other hand,
thought of his hooks as loyal friends who had served him well; to him they
were "nice shiny little hooks." Harold notes: ". . . The prospect of going
through life with steel claws terrified me. That would mean I'd be openly
advertising the fact that I was a cripple and a freak. Besides, they were
gruesome and repulsive to look at" {1949 A2).^ He therefore looked
toward the cosmetic artificial hand in the hope that it would cover up
his handlessness. Desperately he asked an old-time hand amputee, "Were
they [the cosmetics] any good? How well did they work? Did they really
look like the genuine article?" (p. 43). The old-timer replied:
"Ah reckons they ain't so hot, son, else more folks'd be usin' 'em." He
chuckled and clacked his hooks together like a seal clapping his flippers; they
gave off a dismal, hollow sound. "No, suh! Gimme mah nice, shiny little hooks
anytime! Yuh c'n do anythin' with 'em, positively anythin', suh!" [p. 43].
Harold continued to be filled with horror at the thought of going
through life with hooks until he discovered for himself that the hooks
worked, whereas the cosmetic hands did not. It is noteworthy that from
2 Harold Russell with Victor Rosen, Victory in My Hands, copyright 1949.
Used by permission of the publishers, Farrar, Straus, and Cudahy, Inc.
62 Physical Disability — A Psychological Approach
then on he thought of the hooks as hooks or artificial hands or working
hands, and of the cosmetic prosthesis as "phony hands."
It didn't take me long to discover my mistake. The "cosmetics" looked all
right, though the gray gloves gave me a clammy feeling and reminded me of
pall-bearers hauling a coffin. What was more important, however, was that they
didn't work. To begin with, only the thumb and index finger could be moved
at all; the other three fingers were stationary. Then the normal position of the
two functional ones were open. That meant that when I wanted to grasp some-
thing and hold onto it I had to exert constant pressure in order to keep the
fingers closed. That was both tiring and disturbing. If I relaxed for just an
instant, I'd drop whatever I was holding. I was under steady physical and
mental strain everytime I picked up something.
The following morning I went back to the workshop. I traded the phony
hands for a pair of hooks. Maybe they didn't look so good, but they worked. I
found that out right away. I pulled out a cigaret and lit it. It took a little
struggling, but I was able to do it, which was more than I could say for the
hands. I left the shop feeling that maybe things weren't going to be so bad,
after all [pp. 99-100].
Though at this point Harold still had a long way to go before he could
approach full acceptance of his hooks, the groundwork was well laid. The
hooks had become secured within the frame of coping rather than of
succumbing.
By the same dynamics, Noreen Linduska (1947) was able to see her
braces as aesthetically pleasing, whereas they were abhorrent to an out-
sider. When Noreen described them as beautifully chromium plated, a
woman felt that she was being "gruesome" (p. 189).
Another incisive example is the reaction of Karen and her mother when
they saw Karen's crutches for the first time. Karen, now 7, had never
walked. For years she had been slowly conquering the limitations of
cerebral palsy by diligent application toward self-help in feeding, washing,
and dressing, and by development of sitting balance, active reciprocal
motion, etc. After what seemed like interminable waiting, the crutches
finally arrived. They were glorious, because they meant not incapacity but
tools with which to walk:
... I [Karen's mother] threw the package on the couch and scampered off
for a pair of scissors. It took a few minutes but finally I was down to the box.
I took the box and placed it on the floor in front of Karen. Reverently I raised
the lid. I looked at Karen. She was staring down, spellbound.
There in all their gleaming beauty were our crutches. "Isn't the wood beauti-
ful," she said in a hushed voiK.
Salufary Status Position 63
Lifting her out of the bars, I sat her on the ottoman. My hands trembled
as I hfted the crutches from their box. Wood or wings? [Killilea, 1952:215].^
Of course, the perception of succumbing aspects and the resultant aver-
sions may be invested with quite widely differing emotional contents. An
example of deeply morbid preoccupation is the reaction of Miss M.,
observed in an experiment on the emotional reactions of nondisabled
persons to a cosmetic hand (Cattell et al., 1949). The subject was in a
small group that included a young man wearing a cosmetic hand pros-
thesis. Unable to bear the sight of the hand, she left; when interviewed
later, she spontaneously said:
"It nauseated me. That's why I ran out. The sandwich [which she had been
eating] began to smell ... I smelled it again. The look of the hand where it
came to the ridge . . . discolored, yellow-greenish" (grimaces and shows
disgust and shrinks from the discussion and has to be encouraged to go on)
[p. 62].
After continued discussion Miss M. pointed out that "It looked like
nothing. It looked like death" (p. 63).
What is important to realize is that Miss M.'s marked aversion to the
yellow-greenish color is comprehensible when seen as linked to emotional
contents that destroy the person, in this case the association of death. To
be sure, negative reactions can be aroused by other than succumbing
features; for example, the cosmetic hand may be rejected because it does
not fit the build or personality of the wearer. But where there is aver-
sion and not just disapproval or regret, the evaluator is overwhelmed by
the perception of succumbing rather than coping aspects. What may be
gruesome to one may be gratifying to another, for in the one case it
signifies troubles and heartaches and in the second case solutions and
adjustments.
Underlying Conditions
The pressing question, then, concerns the conditions that give focus to
the coping rather than the succumbing possibilities in situations involving
serious difficulties. One important condition concerns the position of the
person with respect to the disability situation — i.e., whether he is an
intimate part of it or an outsider looking in. In general, the inside position
is characteristic of the person with the disability himself, persons close to
him such as family and intimate friends, and those directly involved in
3 Reprinted with permission of Prentice-Hall, Inc., from Karen by Marie
Killilea. Copyright 1952 by Marie Lyons Killilea.
64 Physical Disability — A Psychological Approach
his welfare, such as rehabilitation workers and vocational counselors.
Typical of the outside position is that of strangers or persons who feel
little connection with the fate of the person with the disability.
In the former case, the person and those concerned about him not only
wish for success but are actually faced with the necessity of coping with
the difficulties; both wish and necessity persistently emphasize various
coping possibilities.
In contrast, the need to cope with disability problems may not be felt
by the stranger or the casual acquaintance. Such a person sees only the
hardships imposed by the disability. Moreover, he may in many instances
overestimate the extent of the limitations because he views them from his
own vantage point rather than from that of a person with the disability. If
he could assume the inside position, he would not, for example, be puzzled
when a blind person attends the movies for, after all, he himself enjoys the
radio without benefit of visual stimulation. Yet, because of his outside
psychological position, many a sighted person remains incredulous. The
emphasis on the succumbing as against the coping possibilities is one
important factor, we believe, in the surprise, if not doubt, of many persons
when informed that handicapped and nonhandicapped groups are for the
most part indistinguishable with respect to health of personality.
There is yet another factor — namely, the requirement of mourning (see
pp. 242-243) — that predisposes the outsider toward emphasizing the
aspect of succumbing to difficulties. When the security of the outsider
depends upon maintaining his high status with respect to physique, he will
have a need to emphasize the negative aspects of disability and to expect
and even demand that a person with a physical disability pity himself.
Thus, the lack of a need to perceive coping possibilities and the existence
of a need to perceive succumbing aspects may combine in the outsider
with such uncontested force that he pitilessly "pities" a person with a dis-
ability. Other outsiders, although they may genuinely wish the person
success, may not have the opportunity to become aware of coping possi-
bilities.
Implications for Rehabilitation and Education
Originally, agencies on behalf of persons with disabilities were organized
to give comfort to the afflicted, to make the lot of the handicapped some-
what easier. Increasingly, the efforts of organizations are being directed
away from charity and toward constructive effort.* Fraternal and social
* Allan (1958) presents a comprehensive and enlightening review of current
rehabilitation activities as shared by the many disciplines and the broadw
community.
Salu+ary Status Position 65
organizations of all kinds are making tangible contributions toward reha-
bilitating persons with disabilities rather than merely solacing them. The
focus on succumbing to disability leads to charity, the focus on coping
to rehabilitation.
The best rehabilitation procedures contribute enormously toward bring-
ing into focus the possibilities of coping with difficulties. For example, the
emphasis on what Rusk and Taylor (1953) have called "activities of
everyday living" directs the person to deal with the concrete here-and-now
demands of getting along. When a paraplegic patient learns to move from
the bed to the wheel chair, from the wheel chair to the floor, he is learning
something more important than a new physical skill; he is learning that
he can improve his situation and that in coping with the many "little
things" he is coping with the biggest thing of all: gaining self-respect. It
has been said that working with daily-activity skills is the basis for all
subsequent rehabilitation processes. This is as true for the restoration of
self-respect as it is for the restoration of physical independence. The
emphasis on coping is caught in the following two rules stressed by the
Institute of Physical Medicine and Rehabilitation at Bellevue Hospital,
New York, namely: "You can't disable ambition" and "You still have a
lot more ability than you have disability."
Success stories can also aid a person with a recent disability by high-
lighting the reality of coping successfully with the attendant difficulties.
The story is told of a Marine flying officer whose left heel and entire right
foot were amputated by the propeller of an enemy plane while he was
parachuting from his own destroyed plane. Upon landing in the water,
he inflated his life raft, applied a tourniquet, and waited to be picked up
by a crash boat. When later he was asked what he thought of when he
was administering first aid he answered, "I thought of an article I had read
about Alexander de Seversky and how, although he lost a leg in the First
World War, he was able to continue flying, and became one of the great
men of the world in aviation. I thought, if he could do it, I could, too!"
(Rusk and Taylor, 1946:12).^ What this Marine officer realized was that
the world still could reserve a useful place for him, that all the important
things of life were not lost with his foot.
Without a doubt, some success stories serve to augment the feeling of
self-pity. Inspirational stories about a person with a handicap may exude
self-aggrandizing feelings on the part of the writer that kindle the flames
of devaluation in the reader. It is enlightening to read the following
account with the eyes of an amputee, sensitizing oneself to the emotion/^J
undertones of the message rather than to the straightforward mteuectucn
5 H. A. Rusk and E. J. Taylor, New Hop« for the Handicapped, narper «
Brothers, 1946. By pennissioa.
66 Physical Disability — A Psychological Approach
statement. It is a news story about Pete Gray, the baseball player, who
lost his right arm when he fell from a truck at the age of six: "Gray is an
inspiration to practically every wounded veteran. The mere fact that a
one-armed ball player has crashed the big leagues opens up new and
electrifying vistas for each of them. If he can overcome his handicap in
such fashion, there is hope for them all" (Rusk and Taylor, 1946:140).
Particularly the last phrase, "there is hope for them all," carries the sting
of "You poor fellow, don't worry, there is still hope for you."
In contrast, consider the following account of Bill Talbert, the
United States Davis Tennis Cup star, who must daily remember the fact
that he has diabetes. "In the fourteen years Talbert has played tournament
tennis, he has competed in some five hundred events, has traveled more
than three hundred thousand miles, and taken more than ten thousand
insulin injections. Diabetes has not interfered with either Talbert's tennis
playing or his personal life, for he has learned to live with his disability"
(Rusk and Taylor, 1946:131). There is no pity in this description. But
there is an awareness that the disability plays a role in Talbert's life, a role
defined by his efforts to cope with its impositions.
Even more than success stories, knowing or seeing how others with like
problems manage successfully may provide the realization that it is
possible to do so. Pearl Buck received such support as a parent of a
retarded child when she needed it most:
I learned at last, merely by watching faces and by listening to voices, to
know when I had found someone who knew what it was to live with sorrow
that could not be ended. It was surprising and sad to discover how many such
persons there were and to find how often the quality I discerned came from
just such a sorrow as my own. It did not comfort me, for I could not rejoice in
the knowledge that others had the same burden that I had, but it made me
realize that others had learned how to live with it, and so could I. I suppose
that was the beginning of the turn. For the despair into which I had sunk when
I realized that nothing could be done for the child and that she would live on
and on had become a morass into which I could easily have sunk into useless-
ness [Buck, 1950:31].^
The positive psychological effect of seeing others like oneself manage is
an important reason for at least some of the rehabilitation workers to have
disabilities similar to those of their patients. An occupational therapist
with a hook prosthesis can teach arm amputees a good deal more than
the mechanical use of prosthetic devices. He can teach them not only that
it is possible to become physically independent but also pride in achieve-
ment that stems from acceptance of a disability:
« Reprinted by permission of Harold Ober Associates, Inc. Copyright. 1950,
by Pearl S. Buck.
Salutary Status Position 67
. . . Sure, it was easy for her [an able-bodied occupational therapist] to
show me how to turn on a water faucet or drop a coin in a box. All you did
was thus and so, and then they'd demonstrate for me. That didn't mean much
to me. Of course they could do it themselves. They had hands. But if someone
with hooks had demonstrated how to open a window or turn a faucet not with
hands, but with hooks, he would have made a deep and lasting impression on
me. Then I wouldn't have left Occupational Therapy every day saying to
myself. That's all very fine and wonderful, but — [Russell, 79-^9.104—5].
Parenthetically, an occupational therapist who himself has the particular
disability is likely to have worked out tricks and short cuts that may not
be a part of the nondisabled therapist's repertoire:
. . . they taught me in Occupational Therapy to pick up a cup of coffee by
slipping my hook through the handle. That was all wrong. I had no control
over it that way. The weight of the hquid would pull it down. To keep it from
spilling I'd have to steady it with my other hook. After awhile I learned by
myself that it was better to grip the handle between the prongs of one hook,
thus leaving the other free [Russell, i9'^9;103].
The difference between perceiving diflBculties in terms of coping and of
succumbing provides one important basis for evaluating educational
projects, such as films and publications, which are intended to develop
more favorable attitudes on the part of the public. K the project pre-
dominantly portrays suffering or succumbing, and minimizes the coping
possibilities, the dominant emotions it arouses will be devaluating pity
and/or fear. Unfortunately there are many instances where the emphasis
is on the wrecked lives of paraplegics, on the horror of cancer, on the
devastating effects of blindness, and so on. To be sure, many projects,
primarily designed for fund-raising, have been based on the assumption
that giving is most effectively stimulated by pity. This assumption is in
itself questionable and should be subjected to experimental test. In any
case, because emphasis on the catastrophic effects of disability iU prepares
the public for the eventuality of coping with disability problems them-
selves or for satisfactory interpersonal relations with others who have
disabilities, such propaganda is of questionable value.
Sometimes the educational effort is aimed at arousing the audience to
follow certain health practices. For example, a cartoon selected for a
Pulitzer award portrays a small boy on crutches watching from the side-
lines other children vigorously playing football. It is captioned, "Wonder
why my parents didn't give me Salk shots?" The psychological soundness
of such propaganda is highly questionable. The cartoon arouses pity, yes,
but does it accomplish the purpose of shaping helpful attitudes and
prompting constructive action? As an alternative, it is proposed that the
68 Physical Disability — A Psychological Approach
public can be educated toward the importance of safety and of medical
care by information concerning precautionary measures and treatment
procedures rather than the horrors of disease, disability, and neglect. In
terms of our theoretical framework, it is the aspect of coping with the
problem that should be pointed up rather than the possibility of succumb-
ing to it.
There is some experimental evidence supporting this thesis in a study
of the effectiveness of different kinds of information in producing attitudes
and behavior in accord with a set of recommendations (Janis and Fesh-
back, 1953). Three types of information varying in the amount of fear-
arousing material were presented in an illustrated lecture on dental
hygiene: The Strong Fear presentation emphasized and graphically illus-
trated the threats of pain, disease, and bodily damage. For example, it was
stated that "if you ever develop an infection of this kind from improper
care of your teeth, it will be an extremely serious matter because these
infections are really dangerous. They can spread to your eyes, or your
heart, or your joints and cause secondary infections which may lead to
diseases such as arthritic paralysis, kidney damage, or total blindness"
(p. 79). The Moderate Fear presentation described the same dangers in
a milder and more factual manner. The Minimal Fear variation rarely
referred to the unpleasant consequences of improper dental hygiene.
Instead, it substituted relatively neutral information dealing with the
growth and functions of the teeth. Each of the three presentations in-
cluded the same recommendations as to the proper toothbrush and tooth-
brushing practices, and the importance of dental consultations. Translating
into our terminology, we can say that the Strong Fear presentation
emphasized succumbing potentialities whereas this emphasis was almost
absent in the Minimal Fear presentation.
The three types of lectures were heard by equivalent groups of high
school students as part of the school hygiene program. In order to
observe changes produced by the illustrated talks, questionnaires about
dental hygiene beliefs and practices were administered to the subjects one
week before the experiment, immediately after the experiment, and again
one week later.
The results suggest that "under conditions where people will be exposed
to competing communications dealing with the same issues, the use of a
strong fear appeal will tend to be less effective than a minimal appeal in
producing stable and persistent attitude changes . . ." (p. 86) and
conformity to recommended protective actions. The specific results follow.
1. The fear appeals were successful in arousing affective reactions. Im-
mediately after the communication, the group exposed to the Strong appeal
reported feeling more worried about the condition of their teeth than did the
Salutary Status Position 69
other groups. The Moderate appeal, in turn, evoked a higher incidence of
"worry" reactions than did the Minimal appeal.
2. The Strong appeal evoked a more ambivalent attitude toward the talk
than did the other two forms. Though the students exposed to the Strong appeal
were more likely than the others to give favorable appraisals concerning the
interest value and the quality of the presentation, they nevertheless showed the
greatest amount of subjective dislike and made more complaints about the
content.
3. The three forms of the illustrated talk were equally effective with respect
to (a) teaching factual content, as assessed by an information test, and {b)
modifying beliefs concerning the proper type of toothbrush.
4. In practice the greatest amount of conformity to the recommendations
was produced by the Minimal appeal. The Strong appeal failed to produce any
significant change in dental hygiene practices, whereas the Minimal appeal
resulted in a reliable increase in conformity, as compared with a control group.
Similarly, more of the students of the Minimal appeal group went to the
dentist during the week following the experiment than of the Strong appeal
group.
The investigators conclude that "when fear is strongly aroused but is
not fully relieved by the reassurances contained in a mass communication,
the audience will become motivated to ignore or to minimize the impor-
tance of the threat." (Janis and Feshbach, 1953:92). Implications for
propaganda and education concerning other threatening situations such
as the atom bomb are also drawn in the study.
More research is needed utilizing different contents, subjects, and types
of succumbing and coping materials. Nevertheless there seem to be sound
theoretical support and some experimental evidence for centering on
coping. Rusk and Taylor's Living with a Disability is an admirable ex-
ample of depicting problems of disability as problems of coping and
adjustment (1953). This is also true of such films as A Place in the Sun,
which shows children with cerebral palsy learning activities of everyday
living, such as eating, shoe-lacing, writing, sitting.
Films that picture the person with a disability managing the ordinary
affairs of living also offer excellent training for the recently disabled. The
psychological impact that such a film can carry is seen in Harold Russell's
(1949) experience two months after he lost his hands:
. . . Meet McGonegal was the story of a man who had lost his hands in
World War I. McGonegal . . . had been faced by the same problem I was up
against and he had licked it. . . . There was no plot to the movie, at least not
in the ordinary sense. But for me it had a tremendous impact. It told me that
any handicapped person could get along fine and take a normal place in society
if he really wanted to. The picture showed a typical day in Charley McGone-
70 Physical Disability — A Psychological Approach
gal's life: It showed him dressing himself, shaving, brushing his teeth, combing
his hair, eating breakfast, smoking, drinking, reading, shooting a game of pool
and writing a letter — with a fountain pen, like a grownup, instead of with a
pencil, like a child.
It was the most exciting movie I had ever seen. When it was over and the
lights went up again I said to myself, if he could do it, I can do it, too [pp.
105-106].
The difl&culties and problems in these films are not minimized or sugar-
coated, but they are understood in the light of the efforts of the individual
to meet them rather than succumb to them.
Coping is not only desirable from the educational point of view but is
also very much in accord with reality. Though such feelings as fear, help-
lessness, and hopelessness may overwhelm the person in his initial adjust-
ment to disability, his will for growth and personal integrity most often
shifts the balance in favor of coping with his problems. He may not cope
as successfully as we would like, but he does think and act in terms of
managing the difficulties that beset him.
EXPECTATION DISCREPANCY
It is of far-reaching consequence that the expectations concerning the
behavior and adjustment of persons with a disability are often discrepant
with the apparent behavior and adjustment — that is, with what the subject
observes. We shall call this the expectation discrepancy. The "subject"
as used here will apply to the person whose expectations and other per-
ceptions we are examining, be he the person with the disability or the
person viewing him. The expectations can be worse than the apparent
reality or better.
The subject who has these discrepant expectations will react with some
feeling appropriate to the gap between the expected and apparent state of
affairs and to the direction of that gap. Where the expectations are worse
than what he observes, he may be:
Surprised — "Despite their severe disabilities, the mental health of the
veteran paraplegics as a group is surprisingly good."
Incredulous — "It's unbelievable, but he can even shave with those
hooks!"
Where the expectations are better than the presenting facts, the subject
may be:
Anguished — "I felt sick. The last hope that I might again see perfectly
was gone."
Salu+ary Status Position 71
Disappointed — "I had hoped this final operation would be successful,
but she still can't bend her knee."
Assuredly, there is a wide gamut of emotional reactions to expectation
discrepancy. Such feelings as amazement, wonder, curiosity, dismay,
horror, frustration, futility, etc., could be added, but there is little in the
way of research to assist us in delimiting the possibilities. It seems reasona-
ble that if the direction of the expectation discrepancy is in accord with
the subject's wishes, a positive affect emerges, such as "pleasant surprise"
Qr hopefulness. If, however, the expectation discrepancy runs counter to
his wishes, a negative feeling is experienced, such as disappointment and
frustration.
Though it might appear that a positive reaction would be typical in
cases where the state of affairs turns out to be better than anticipated, we
must not forget that the subject, under certain conditions, might wish a
worsening or a maintaining of the unfortunate situation. In the case of
the person with a disability, this occurs when he does not wish to get
well, when secondary gains are contingent upon his remaining disabled.
In the case of someone else, this occurs when the principle known as the
"requirement of mourning" operates (see pp. 242-243). Then it is that
the subject may actually feel dismayed should he perceive the person with
the disability as "better off" than he expected and quite content to find the
reverse.
In addition to the subject's immediate reaction to the discrepancy
between his expectation and presenting fact, he has a need to explain it, to
fill in the gap, so that there is a reconciliation between the two halves of
the equation, i.e., expectations on the one hand and the apparent realitj'
on the other. How this reconciliation takes place also has important conse-
quences for the evaluation of a person with a disability, but first we need
to inquire as to the conditions giving rise to expectation discrepancy.
Conditions Underlying Expectafion Discrepancy
How does it happen that there is a discrepancy between what the
subject expects of the behavior of a person with a disability and what at
some later time he experiences of that behavior? Several conditions may
be mentioned:
1. Spread — the subject perceives the person (or himself) as a "disabled
person." That is, the person is seen as disabled not only with respect to
physique but with respect to other characteristics as well — e.g., personality
and adjustment (see pp. 118-119). This spread appears to be particularly
fluid when the subject is in a comparative frame of mind — that is, when
he is evaluating the person with respect to some preconceived standard
72 Physical Disability — A Psychological Approach
(see pp. 128-133). Because of "spread," the subject expects the lot of the
person with a disability to be worse than the apparent reality. Such spread,
then, often accompanied by devaluation, becomes paradoxically a condi-
tion for the subsequent wonder and admiration at the proved accomplish-
ments of the person with a disability.
2. Position of the subject — when the subject is in the position of an
outsider — that is, when he is actually little concerned with the fate of the
person with a disability — he will view the problems attendant upon the
disability from his own perspective. This means that he will see the prob-
lems of the situation in terms of his own "equipment" as a person with
the usual physical advantages and be unable to discover new ways of
meeting these problems (see pp. 63-64). In their insolubility the prob-
lems loom large indeed, and hence the expectations may be worse than the
actuality. Were the subject closely aligned with the disability situation,
either as the person with the disability himself or one close to him, then
the necessity of meeting the problems of living would reveal to him the
pertinent truth, "there is more than one way to skin a cat." When coping
is enhanced, negative expectations are reduced and sometimes may even
be underestimated.
3. Requirement of mourning — when the security of the subject depends
upon physique as a high status value, he will tend to insist that the lot of
a person with a disability is an unfortunate one (see pp. 242-243).
Exaggerated negative expectations are part and parcel of this need and
point to an important source of expectation discrepancy.
4. Wish for improvement — Sometimes the wish that all will be well is
so strong as to lead to unrealistic expectations of marked improvement or
eventual recovery. Even though current difficulties may be played down
because of this same wish, the fact that the hopeful expectations cannot
materialize means a discrepancy with reality that is at best disappointing
and at worst heartbreaking. We should also expect that a person with such
a strong wish would show other differentiating emotions; for example, he
is less likely to be amazed or surprised at the positive adjustment and
accomplishments of a person with a disability and more likely to be
pleased than would the outsider who does not actively entertain the wish
for improvement.
5. Blurring of perception owing to anxiety — Both the expectations and
the apparent reality may remain obscure because of the tide of anxiety
that keeps the subject, as it were, in a daze. Then it is that such emotions
as worry, depression, antipathy take hold, and emotions arising from
expectation discrepancy, such as anticipation, surprise, disappointment,
etc., cannot appear until there is a clarification and differentiation of one's
expectations and the apparent reality.
Salutary Status Position 73
Reconciling the Expectation Discrepancy
It is part of the nature of man to search for explanations and connec-
tions so that his experiences in the world about him become comprehensi-
ble. So it is in the case of expectation discrepancy. It is disturbing to the
subject when his expectations do not match the presenting facts, and he
feels a need to reconcile the two. This may be accomplished by such
cognitive changes as expectation revision, altering the apparent reality,
and anormalizing the person. These means will be illustrated by several
different cases of expectation discrepancy.
Let us consider the frequently occurring expectation discrepancy where
the performance of the person outstrips the expectations of the subject.
Assume that the subject in question is in the position of an outsider who,
faced with the discrepancy, attempts to explain it. Because of this, he may
cease ruminating about succumbing to the difficulties, i.e., emphasis on all
the things the disability denies, and instead become concerned with the
coping aspects, i.e., the ways in which the person has managed. In so
doing, the subject begins to recognize the adjustment possibilities of a
paraplegic, a blind girl, or an amputee, and is then able to agree with
Miers (1953), for example, that ". . . my athetosis ... is not half the
nuisance you think. Straws for drinking, a typewriter for putting my
thoughts on paper, an electric razor, in the main cut down this disability
to life size" (p. 7). Not only will the coping aspect of difficulties have
become dominant, but the subject will have also shifted his position to that
of the insider.
These two shifts give a new direction to the original amazement over
the adjustment of the person with a disability. The expectations of the
subject have been revised upward so that he is no longer incredulous. This
does not mean that he is left with a simple nonchalance of fulfilled expec-
tations. He may now, for example, feel respect for the persistence shown
by the person with the disability in meeting his difficulties, or he may
feel that it took courage or ambition or earthy common sense regarding
the realities of life to do so. These positive feelings emerge when coping
with as against succumbing to the difficulties is in the field of concern.
Although this perceptual change for resolving the discrepancy is to be
desired, the social-psychological position of the subject is not always
conducive to such a shift in emphasis. For example, there may be little
opportunity for the subject to learn just how the person with a disability
does manage. This is particularly true if the subject is an outsider, for
not only does he lack ready opportunity for coping discoveries but he has
little need, other than that produced by the gap, to create such oppor-
tunities. Instead, the subject may seek other means at reconciliation.
He may, for example, alter the apparent reality by doubting the evi-
74 Physical Disabilify — A Psychological Approach
dence concerning the adequate adjustment of the person with a disability.
Thus, he may feel that the person is shamming, simply acting as though he
were managing, when actually he is not. He may suppress evidence re-
garding the coping aspect of difficulties and high-light evidence bearing
upon the succumbing aspects: for example, he may not "see" how well
the child with braces gets around but may notice primarily that the child
walks with a halting gait. He may tend to attribute all the discomforting
aspects of the person's life to the disability, though they may have little
actual connection and, in spite of all indications that the person has
arranged his life in accord with his abilities and is living satisfactorily, he
may insist that the person's lot is lamentable. Chevigny {1946), as a blind
adult, sometimes could not help feeling that the world "doesn't want to be
convinced that I am not altogether helpless, despite the plain evidence to
the contrary" (p. 76). Unfortunately, this means of fitting together the
expected state of affairs with the apparent state is probably not infrequent.
Where the "requirement of mourning" (see pp. 242-243) is felt to insure
the security of the subject, this method becomes a cunning maneuver.
Altering the apparent reality requires some fluidity in the perception of
the reality, i.e., what is perceived cannot be boimd too tightly to the objec-
tive reality but must be responsive to the manipulations of the wishes and
beliefs of the subject.
Finally, the discrepancy may be reconciled when the subject "anormal-
izes" the person, i.e., attributes to him certain unusual characteristics,
even supernatural ones, so that the ordinary expectations do not apply. It
is very much like the kind of anormalization one might experience in the
event of winning the sweepstakes; the incredibility soon becomes cloaked
with a strange feeling that one has been blessed or fated to win in the face
of overwhelming odds. Similarly, when the subject expects the blind man
to fumble and stumble and instead finds him well oriented, it is easy for
him to chalk off this discrepancy by appraising the blind man's sensory
apparatus as literally "out of this world."
Anormalization of persons who are deaf also occurs, as will be seen in
the following fictionalized events:
In Gian-Carlo Menotti's contemporary opera, The Medium, the title charac-
ter and fraud, Madame Flora, intones about the deaf-mute boy she has taken
into her home: "Just because he cannot speak we take him for a halfwit, but
he knows a great deal. He knows more than we think. There is something
uncanny about him. He sees things we don't see." Her vague apprehensions are
ambiguously justified in the course of the opera. Assuming that the deaf-mute
is the real medium for inexplicable phenomena, she is frightened into killing
him, and thus brings about her own downfall.
Madame Flora's recitative is taken up in full chorus by a whole group of
inhabitants of a small town in Georgia, in Carson McCullers* novel. The Heart
Salutary Status Position 75
Is a Lonely Hunter. The spiritually desperate characters come to regard Mr.
Singer, a deaf-mute who Hves in their community, as a kind of God substitute,
and attribute to him many of the characteristics traditionally ascribed to deity.
The author simultaneously points up the irony of the equally anguished con-
cerns of Mr. Singer's own life, so remote from the supernatural vision of him
conjured up by the needs of the other townspeople that his eventual suicide
becomes a poignant mystery and defeat to them.
The same idea again finds expression in a popular movie. Flesh and Fury,
where the boxing skill of a champion prize fighter seems mysteriously to
hinge upon his status as a deaf-mute. When his hearing is restored, and he has
learned to articulate, he finds himself at a total loss in a championship match,
as inept in the face of his opponent as the shorn Samson before the Philistines.
Fortunately, a blow in the course of the fight deprives the hero of his hearing
long enough for him to win the bout [Maisel, 1953. -216-217] J
The person with a disability himself may feel a kind of supernatural
intervention vi'hen he is carried through what appeared to be insuperable
difficulties. Karsten Ohnstad (1942) describes the problem that con-
fronted him when, in crossing a busy thoroughfare, his usual sound cues
were disrupted by wind and the rumbling noises of trucks. Upon arriving
safely at the curb, he felt that in some way he had been magically pro-
tected (p. 68).
When Karsten gained thorough control over traffic hazards by using a
white cane, the anormalization became even more a part of his very
person:
. . . The cane was a nuisance, clattering against everything and catching in
my trouser cuffs as I twirled it idly about like a baton; but at street comers it
proved its worth. Car drivers saw it and stopped. I held it out before me and
walked across the pavement with an assurance that I had never felt before. I
was a worker of miracles. I was the Moses of the metropolis. I held out my
staff over that roaring, honking sea, and lo! the traffic parted, and I stepped
up on the opposite curb sound as a dollar [Ohnstad, 1942:69].
The factor of personal control is probably conducive to the feeling of
deification in contrast to the kind of anormalization in which the person
is felt to be a pawn of fate or subject to control by other supernatural
events. Such personal deification was experienced by Raymond Goldman
(1947) when, unable to walk because of polio, he mastered the "un-
attainable" through the strength of his own will :
. . . Other children learn naturally and without consciojis effort to move
about and crawl and stand up. Not T. I had to achieve thosf things so deliber-
'' Edward Maisel. Meet A Body, by permission of the Institute for the
Crippled and Disabled.
76 Physical Disability — A Psychological Approach
ately, at the cost of so much pain and sweat and tears, that the attainment of
each was a separate triumph. I stood almost in awe of my own power to
accompHsh. I was like a god [p. 38].s
Anormalizing the person with a disability means that he transcends the
laws of ordinary mortals so that expectations relevant to normal persons
do not apply. There is one important difference between the quality of
deified eminence and that of the esteem generated when, through concern
over coping with difficulties, expectation revision takes place in which
higher though entirely normal expectations are maintained. In the former
case, the person with a disability is viewed as a different kind of person;
he is set apart from normal persons and his accomplishments are seen as
resulting from some kind of mystical intervention. In the latter case, the
person with a disability is very much a part of the group of normal human
beings, and his accomplishments are "understood" in terms of natural
behavior.
Conditions for anormalizing the person appear to be favorable when
the perceptions of the two sides of the equation are difficult to change.
Again let us turn to blindness as an illustration: (1) When a sighted
person has the position of an outsider with respect to blindness, he expects
that the locomotion difficulties attendant upon blindness are insuperable.
Moreover, this perception is diffictilt to change. (2) When such a subject
sees a blind person unperturbably getting about there is a discrepancy
with what he expected. Moreover, this perception is also difficult to
change. Seeing is believing, and he cannot deny that the blind person has
safely crossed the street, mounted the stairs, and located his books.
In these circumstances, it is perhaps comprehensible why the person
who is blind should be looked upon with reverence and felt to be equipped
with unusual powers. In fiction, the most frequent stereotype of the blind
is that of the idealized and abnormally good person (Barker et al.,
1953:214). In religious practices, the blind have been accorded privileged
positions (Barker et al., 1953:213). Modern Turkey regards the sightless
as indispensable assets to religious ceremonies and funerals (Maisel,
1953:23). In Greek legend many clairvoyants are blind (Hentig, 1948b:
23). Among the Koreans it is believed that the blind have acquired an
inner vision and they are therefore held in high esteem (Maisel, 1953).
For a review of the factors important in resolving expectation dis-
crepancy, the case of deafness serves well. Commonly, with respect to a
person who is deaf, the subject holds higher expectations than are borne
out by what ensues because the deaf person, looking just like anyone else,
8 The selection from Raymond Goldman, Even the Night, copyright 194'
The Macmillan Company, is used with the permission of the publishers.
Salutary Status Position 77
is expected to act like anyone else. The subject expects the person who is
deaf, for example, to be able to communicate with him but discovers
that he cannot.
Reconciliation of this expectation discrepancy is then initiated. Depend-
ing upon his social-psychological position with respect to the disability
situation, the subject may revise his expectations downward. This is easier
to do when the subject has an objective rather than a more personal,
wishful interest in the welfare of the person. In such circumstances, the
subject seeks honest understanding of "what is wrong" and may discover
that his expectations were unrealistic in the light of the newly uncovered
facts. If in the process of expectation revision the difficulties of deafness
are seen in the light of coping rather than succumbing, positive evaluation
of the person will occur.
However, there will undoubtedly be strong resistance against lowering
the expectation level where there is an overpowering wish for the person
to hear better, this not infrequently characterizing the subject who is in
the position of an insider. In this case, the subject may alter the apparent
reality. He may regard the discrepancy as a temporary one that will be
erased through the efforts of continued cures; the apparent reality is
looked upon as eventually rising upward to close the gap. In the meantime,
insofar as the gap still gapes, the apparent reality will be perceived as
progressively better. Thus the person with a hearing impairment and
those close to him will after surgery tend to feel, as long as the apparent
reality is sufficiently fluid, that there is an improvement, though this may
not at all reflect the true state of affairs. Eventually, it is possible for the
forces of objective reality to become so great as to make such mobility of
the apparent reality difficult and the subject may then turn to a reevalua-
tion of the expectation level.
There are instances of expectation discrepancy in which both the ex-
pectations and the apparent reality resist change. This is true of some
outsider subjects, where neither need nor opportunity exists for the com-
prehension of the difficulties incumbent upon deafness or for upward
shift in the apparent reality. The discrepancy is resolved by anormalizing
the person, and he is dubbed queer or strange or even bewitched.
Anormalization that reconciles a discrepancy in which the expectations
are lower than the apparent reality leads to sanctification, but where the
expectations surpass the apparent reality anormalization leads to vilifica-
tion.
This discussion has permitted, perhaps, some glimpse into the signifi-
cance of expectation discrepancy for the social evaluation of persons with
disabilities. Clearly, further investigation of the conditions underlying
expectation discrepancy and its reconciliation is indicated. We have
pointed out the probable significance of such factors as the position of the
78 Physical Disability — A Psychological Approach
subject, his wishes, opportunity for reevaluation, fluidity of apparent
reality, direction of the gap, etc. Of course, the concepts have application
to nondisability situations as well, just as do the concepts of marginal
position, new situations, value systems, etc., discussed elsewhere in this
volume. The attitudes and behavior of adults toward children, for ex-
ample, frequently can be understood in terms of expectation discrepancy.
Recollection of such an incident with an analysis of possible conditions
contributing to the expectation discrepancy and of the means taken toward
its reconciliation is a worth-while exercise. One must ponder apt illus-
trations from nondisability situations before one can realize with the
conviction of fact rather than supposition that the social psychology of dis-
ability is truly a general social psychology, the laws of which have bearing
upon diverse fields not restricted to problems of disablement.
In addition to the coping-succumbing dimension and expectation dis-
crepancy as factors in the high regard of the person with a disability,
there are two others that should be explicated, namely, the significance of
suffering and outstanding success.
SUFFERING AND UNDERSTANDING
Regardless of the various viewpoints expressed by the psychiatrists and
psychologists, those who have worked closely with the physically disabled
know that having once made the emotional adjustment to their disabilities, they
possess a depth of understanding, patience, and tolerance which is rarely found
among those who have not endured some soul-torturing experience. They have
been forced to discard the superficial and to find the fundamentals. They have
discovered what Robert Burton wrote over three hundred years ago: "Deformi-
ties and imperfections of our bodies, as lameness, crookedness, deafness, blind-
ness, be they innate or accidental, torture many men; yet this may comfort
them, that those imperfections of the body do not a whit blemish the soul, or
hinder the operations of it, but rather help and much increase it!" [Rusk and
Taylor, 1946:12A\.
The point of view that deep understanding emerges from suffering has
more or less vigorously been advanced through the ages by philosophers,
poets, writers, and scientists. It is one of the important factors that evokes
respectful regard for persons disabled in some way. In its more general
application it is represented by the belief that life should not be made too
easy for children in school and society, because only through frustration
and tribulation can the fullness of creativity and wisdom be realized.
Not only professional personnel, but many laymen and persons with
disabilities themselves connect suffering and even great misfortune with
fundamental improvement in the person. In one study on values, for
Salutary Status Position 79
example, the subjects were asked whether they would wish tragedy for
their child (Dembo, 1953a). About half the subjects answered affirma-
tively on the ground that in this way depth of understanding is reached. In
another study, virtually none of the subjects (40 men in the professions)
expressed disagreement with the statement: "I believe we are made better
by the trials and hardships of life." Even when other subjects (an experi-
mental group of 50) were confronted with a presumed group consensus
toward disagreement, only one third went along, whereas two thirds took
a position supporting the statement (Crutchfield, 1955).
Persons with disabilities have, in looking over their lives, also expressed
the feeling that, through the manifold experiences of living with a dis-
ability, they have gained a profound awareness of truly human values.
Harold Russell (1949), who lost his hands as an adult, puts it this way:
". . . this seeming disaster has brought me a priceless wealth of the spirit
that I am sure I could never have possessed otherwise. I have enjoyed a
life that has been full and rich and rewarding, a life that has had a mean-
ing and depth it never had before" (Russell, 1949:218). Raymond Gold-
man (1947), who faced infantile paralysis as a child, deafness as an
adolescent, diabetes as an adult, puts it this way: "Now, I thought, I
could understand the true meaning of life, could see a reason for the
physical and mental anguish I had had to endure, could see the reward
for the struggle I had made. How else could one gain victory except
through defeat? . . . How else could one know happiness except through
suffering and despair?" (p. 159).
In the following account we are brought into a life experience that arose
because of a disability. It took place within three years of a man's blind-
ness and because it did so very much to challenge his understandings and
shape new ones that carried him far in his own adjustment, it is repro-
duced here at some length. The world could well learn the lessons of that
one incident and the revaluation of fundamentals that followed in its
wake. It is told by Chevigny (1946), who became blind at the age of 40:
. . . one noon I was walking up 53d street on my way to the restaurant I
usually frequent for lunch. I heard a genial hail; it turned out to be someone
I knew only as Billy, the office boy at a publishing house where I am
acquainted. I said hello in return, we fell into step — he was going to lunch too
— and I suggested he join me. Billy hesitated, then Jisked, "Are you sure they'll
serve me?" "Of course," I answered, "why shouldn't they?" The next few
minutes were among the most profoundly embarrassing I ever passed. Billy had
to tell me a fact about himself of which I was completely unaware; he is a
Negro.
My embarrassment arose in my instant realization of the predicament in
which I had placed him. . . . Then what seemed a brilliant solution occurred
80 Physical Disability — A Psychological Approach
to me. I said, "You were on your way to lunch — why don't you take me to the
place where you're going?"
"That's a thought," Billy said, and we changed the direction of our walk.
Then I remembered my own problem. Would Bill's restaurant admit Wiz [the
Seeing Eye dog]? I put the question up to him and it was his turn to be
embarrassed — for me. He didn't know about the policy of his restaurant
regarding dogs. He was shocked at the thought that any restaurant would
exclude a man with a Seeing Eye dog. I had my hand on his arm as we walked
and I felt his muscle stiffen as he said, "They'd better let you in. If they don't,
they'll have a Httle trouble putting the roof back on when I get through raising
it." It was a remark that filled me with profound shame. I hadn't offered to
raise any roofs for him. Yet the reasons for his exclusions from restaurants had
infinitely less justification than the reasons for mine.
This story might seem more dramatic had we had the argument we expected
on reaching the restaurant, but we didn't. We were courteously shown to a
table, I put Wiz under it, and we ordered lunch. But it was eaten in silence,
both of us being much too preoccupied with the consideration of the separate
accidents of fate that made our relations with the world difficult.
Walking back to my office, alone with Wiz, my mind was busy with the
implications of this scene. There was the thought of Billy's kindness; it was no
different from that given me by any other man. And had I not been told, in
so many words, that he was a man marked out from the majority I would have
attached no undue importance to it, I would not even have sought to detect
any difference in him. But there was another thought, one almost terrible in
its significance.
Were the whole world blind, there would be no race prejudice. There couldn't
be. The only sense which could have told me that Billy is what is called a Negro
was my sight. No other sense detected any difference. I had nothing but Billy's
own word for it. It was a concept shaking to the intellect. The whole structure of
the majority-minority relationship was perceived in a clear light; its foundation
is that which can be seen, and nothing else. The color of hair, the shade of skin,
the shape of nose — what can perceive them but the eye? It takes hearing to
perceive what is in the heart and mind, and civilized man is too busy using
his eye to listen [pp. 254-256].
My inmost dislike has always been for seeming different from the rest of my
fellow men. Every act of my life has been in the direction of making myself as
close to the norm as possible. I therefore could not now accept the notion that
I had suddenly [when blindness occurred] become inherently peculiar, and that
is the feeling which drove me forward to reattaining as much of my old posi-
tion as I could.
It was a nice comfortable position, my old one, very normal and ordinary.
The tabulated card that represents me in the files of the Census Bureau has
always, in passing through the electric tabulating machines, dropped into the
pockets containing the biggest and fattest bunches of cards. My height and
weight were average, I belonged to the white race, there was nothing exotic or
unusual about the church I attended, my politics were ordinary enough, and
Salutary Status Position 81
I was neither rich nor poor. TTie only time my card ever fell in with the smaller
package of cards was in tabulating professions; but even as a writer I was dis-
tinguished by being neither very good nor very bad. I was safe in the bosom of
the majority. . . .
Now suddenly an important diflference had developed between the majority
and me. . . .
That I resented it shows that my thinking was of the very stuff of which
intolerance is made. I was of the majority and I thought like it. That means I
was conscious of such things as differences between people and classes and
groups.
It took a long time, and not until after the meeting with Billy did I fully
realize that I was carrying with me the very body of fixed notions against
which my resentment was now directed. Those fixed notions were based on
sight, that sight I no longer had; . . . Now, if I wanted to do it, I could get
to the heart and the mind of a man right away without first reading into him
a whole set of attributes because I could see the color of Kis skin or the shape
of his nose.
I think a good deal of the inward part of my adjustment formed about that
time. . . . What happened was that there didn't seem any longer to be too
much need to belong to the majority, to be a regular. The important body to
which to belong was mankind itself, every member of which laughs when
tickled and bleeds when pricked. That there is such a body — ^well, that too I
had merely been told; now I could know it emotionally.
The rich experiences with friendships of the past previous months fell into
place with these new concepts. The friends who so magnificently came to my
assistance were Christians, Jews, and men of no faith at all. Their political
beliefs were as varied. Yet when they came to my bedside as I lay in the
hospital and offered the means to erase worry from my mind about both the
present and the future, their thought was only that I was a fellow man who
needed help. They defended me from the tragedy of my position; I can do no
less, when the need arises, than to defend them from the tragedy of theirs.
These are among the understandings of living I have gained under blindness.
As a writer they are of great importance to me and have added much to my
desire to express what I know and feel. They are of even greater importance to
me as a human being; I still can hate, but only ideas — not people [pp. 258-
261].9
A hundred new thoughts occurred to Chevigny that day. And in the end
not only did he attain higher social values but he also made possible an
inward adjustment that was fundamental and satisfying. He realized in
the depths of his emotional core that one does not have to belong to the
majority group in order to be as worthy as any man. He realized that
sight, the queen of the senses, may also become the servant of malice that
9 H. Chevigny, My Eyes Have a Cold Nose, Yale University Press, 1946,
By permission.
82 Physical Disability — A Psychological Approach
divides man against man on the basis of the most superficial criteria. And
in so reahzing, he and others through him gained that which is priceless.
Chevigny is a man of high intellect. Could the ordinary person with a
disability reach such fundamental understandings? Harold Russell {1949),
on the basis of wide observation, thinks so. He is convinced, for example,
that racial intolerance wanes in the sick and disabled in general:
During my tour ... I visited dozens of Army and veterans' hospitals. I
talked, not only with hundreds of amputees like myself, but with paraplegics,
spastics, and the badly mutilated. I also visited several Canadian Army hospi-
tals. I carried away one more conclusion from these hospitals: Neither dif-
ferences of nationality, race, nor religion counted for much among the sick or
disabled. All were united by the common bond of illness and suffering. It was
only among the so-called healthy that I found the seeds of disunion and
hatred [p. 237].
As far as we know, there are no objective studies on this point. Clearly,
much is needed in the way of research that will sharpen our understand-
ing of the connection between certain kinds of life experiences and the
attaimnent of deep understanding of what really matters. We would
support the hypothesis that ''''soviX-searching" experiences are essential for
the attainment of depth of understanding of the truly important, but we
at least question the role of "souL-torturing" experiences. Although there
is good evidence that one may rise to great heights of emotional under-
standing from the depths of despair, this may not prove to be the course
par excellence. The course may be too thorny, too tortuous, so that the
soul-torturing of too few will find the light through the darkness. Soul-
searching experiences need not be predicated upon soul-torturing experi-
ences, but what they do require needs further theory and test. It is the
process of adjusting to the suffering (see Chap. 5) that leads to sifting out
the trivial from the important and in this way to deeper understanding of
the basic underpinnings of human values.
OUTSTANDING SUCCESS
Just as an inferior position with respect to a single characteristic may
lead to devaluation of the total person (see pp. 131-132), so outstanding
success in a particular area may spread so that the person in general is
looked up to. Henry Viscardi (1952), dwarfed by misshapen legs, remem-
bers how much becoming an expert marbles player did for his standing in
the gang:
In the years that followed, imder the tutelage of Marble Bags I gradually
became the immies champ of our block, and my self-esteem grew along with
Salutary Status Position 83
my big bag of marbles. In later years I was often to think with pride of that
little achievement, as I watched amputees and paraplegics regain a feeling of
personal dignity through mastering the art of doing something well with their
hands [pp. 27-28].io
When special achievement becomes sufficiently prominent, it may serve
the person well by becoming the organizing characteristic for status
evaluation around which other characteristics of the person will be seen.
Since a physical disability has in our culture a high potency, however,
any special achievement has a very deft competitor in becoming a stable
organizing characteristic for status evaluation. Franklin Roosevelt may be
admired by countless persons — but one must note that being President of
the United States is sufficiently distinctive to make insignificant the fact
of disability. Henry Viscardi was a champion marbles player among his
friends, but an "ape man" to many of those who did not know him as a
person. One usually cannot wear one's laurels for all to see, not even in
the manner of a titular appurtenance such as M.D. or Ph.D.
Of course, apart from its social reward, high competence of any kind is
potentially a strong asset in personal adjustment. "Any measures designed
to encourage the development of some areas of excellence will help to
reduce if not prevent an inferiority complex" (White, 1948:156). Needless
to say, the potentialities of the individual must always be the guiding
factor, for pressures to achieve where the "stuff" is lacking are likely to
weigh down the person yet further with inferiority feelings.
As was mentioned earlier (pp. 65-66), success stories may be helpful
in counteracting devaluation of the person by emphasizing the possibilities
in his situation for coping and by leading to the realization that the indi-
vidual is not a disabled person but a person with a disability. Physique
becomes subordinated to other characteristics that have given status to
the person. Persons with loss of limbs who have made outstanding contri-
butions in diverse fields are: Bill Stern the sports broadcaster; Alexander
de Seversky, the aircraft designer; Al Capp, the cartoonist; Herbert
Marshall, the actor; and Jimmy Savo, the comedian. All these persons
lead normal, busy, profitable, and interesting lives and are known first as
respected individuals so that the disability is put in its place when it is
disclosed. If among persons who rose to fame one were to point out
those who have lost limbs, are blind, deaf, paralyzed, etc., the list would
become long indeed. Such a list taken from an earlier German compila-
tion has been reproduced in Boorstein (/9J5.106-110). It includes the
names, and in some cases short biographies, of almost 500 cripples.
10 Henry Viscardi, Jr., A Man's Stature. Copyright, 1952, by Henry Viscardi,
Jr. Used with permission of the John Day Company.
84 Physical Disability — A Psychological Approach
The contribution of outstanding success to the development of healthful
attitudes toward disability may be seen as being mediated by the follow-
ing: (1) it highlights coping possibilities, (2) it subordinates physique as
an organizing characteristic for status evaluation. At the same time, as we
have previously stressed (pp. 65-66), the uncritical use of success stories
may carry its own defeat by actually connoting devaluation of persons
with a disability.
DILEMMA OF CONTRADICTION IN STATUS
Finally, it should be mentioned that perceptions and beliefs that bring
about inferior status exist side by side with those that bring about salutary
status. This juxtaposition may lead to a complex admixture of devaluating
pity and respect in the same social relationship, as exemplified in an
incident recalled by Karsten Ohnstad (1942) while he was a pupil at the
school for the blind:
The woodworking room was one of the favorite stops of visitors to the
school. They swelled our heads with admiration for our work, then deflated us
with pity. One of them looked sadly at my basswood box.
"Is he blind?" she asked the instructor.
"Yes," said the instructor, as sadly as she. "He's blind."
I could feel the woman looking at me incredulously. There was a long pause.
"And he has such fair skin," she mourned, finally [p. 129].
In important relationships such as marriage, contradiction in the status
of the person with a disability may lead to disturbing conflicts. A person
who is deaf, for example, may be held in great esteem because of his
accomplishments as a writer but may be regarded by some as unsuitable
as a marriage partner. A similar dilemma with respect to other minority
groups has been described by Hughes {1945). The point has been made
that being a Negro "tends to overpower, in most crucial situations, any
other characteristic which might run counter to it. But professional stand-
ing is also a powerful characteristic. ... In the person of the profes-
sionally qualified Negro these two powerful characteristics clash. The
dilemma for those who meet such a person is that of having to choose
whether to treat him as a Negro or as a member of his profession" (p.
357). Such dilemmas bring out clearly that status is not an abstract
quality attributed to a person; it always has to do with social standing
within prescribed roles.
Not only does the dilemma challenge the nondisabled person. Incon-
sistency of social attitudes also brings about situations of psychological
Salutary Status Position 85
uncertainty for the person with a disability in which he is unsure as to
how he will be received and what is expected of him (see pp. 99-105).
The conditions under which a person with a disability may be respected
and admired have been reviewed. Recognizing the coping endeavors of
the person is one of these. Expectation surpassed in reality is another. The
belief that suffering leads to deeper understanding is a third. Success so
outstanding that it becomes the distinctive characteristic of the person is
a fourth. That salutary status is part of the social climate confronting the
person with a disability may well contribute to the significant fact that
feelings of inferiority are not generally more characteristic of the "dis-
abled" as a group than of the nondisabled (see p. 52). Yet feelings of
self-depreciation do exist and must become a relatively unimportant
feature in the healthy personality. Before embarking upon an analysis of
the changes conducive to self-acceptance, we should like to examine two
psychological problems important in understanding adjustment to dis-
ability— namely, frustration and uncertainty.
4
Chapter
Frustration and Uncertainty
Psychological analysis can focus either on factors outside the
person or on those within the person. The question of social status, for
example, was viewed on the one hand in terms of the attitudes of others
toward disability and the restrictions and facilitations imposed by society
and on the other hand in terms of the person's feelings about himself. To
take another example, behavior stemming from overlapping situations was
seen in terms of an external set of circumstances as well as its origins
within the person.
This variable emphasis can be understood in terms of what Heider
(1958) refers to as the problem of attribution. He points out, for instance,
that when more or less everyone reacts to a situation in the same way, the
source of the behavior — its underlying conditions — is usually placed in
the environment. Thus, if a problem is diflBcult for all people of a particu-
lar age, the problem is appraised as difficult, not the person as stupid.
Conversely, where there is personal variability, the attribution of the
behavior is to the person. If in this case most persons could solve the
problem, the troubles of a particular person with it would be attributed to
his deficiencies rather than to the nature of the problem. With a full
psychological analysis, however, the nature of the problem and the psycho-
logical processes in the person must both be examined. Actually, this is
just another way of expressing the commonly accepted dictum that be-
havior is a function of both the person and the environment. Thus the
conclusion follows that any behavior under consideration can be partialed
between these two arenas. The double-barreled approach of person and
environment will also be taken in the following discussion.
FRUSTRATION
"By a frustrating situation is meant any situation in which an obstacle
— physical, social, or conceptual, personal or environmental — prevents
the satisfaction of a desire. ... It includes only those situations where
the subject himself accepts the obstacle as impassable, the solution as
86
Frustration and Uncertainty 87
impossible" (Barker, 1938:146). This psychological definition is more or
less the one connoted in common usage.
It is commonly and perhaps naturally assumed that a physical disability
augments frustration. Thus, few persons would see anything contestable
about such statements as: "The handicap of seriously defective vision or
no vision is so obviously shackling, so frustrating, so dispossessing, that
when borne by a child small wonder those who love him feel he is
intolerably afflicted" (Stern and Castendyck, 1950:73). With greater
frustration, it is also assumed that one should find more frustrated persons
among those with physical disabilities, more who show irritability, regres-
sion, restlessness, and other negative effects. Yet somehow none of these
intuitive connections is borne out by experimental test or systematic
observation. The word "systematic" should be emphasized, for certainly
the casual and haphazard glance at everyday experience seems to verify
these a priori connections. Let us first look at research using persons with
disabilities as subjects, and then attempt to integrate the findings into a
clearer understanding of the meaning and management of frustration as
applied to problems of disability.
Two Studies
Kahn's (1951) study is important because it exercised a degree of
scientific care in investigating the problem of the effect of disability on
behavior in frustrating situations all too rarely found in disability research,
Kahn used three groups, each of 15 children between the ages of 9 and
lira group with normal hearing, a moderately hard-of-hearing group with
loss of 15 to 35 decibels, and a severely hard-of-hearing group with still
greater losses. The first two groups attended public schools; the severely
hard-of-hearing children attended a special day school. The subjects were
equated on age, sex, school grade, socioeconomic status, and intelligence
level.
The children participated in two tests of frustration. One, known as
"The Children's Form of the Rosenzweig Picture Frustration Study," is a
projective test consisting of 24 pictures (Rosenzweig et ah, 1948). The
children were directed to write down what they thought the child in each
picture would answer to the person talking to him. The second was a
realistic test of reaction to frustration. The children were directed to
arrange 16 blocks according to a specific pattern before them. The test
was discontinued when the child had been thwarted by ten of the designs.
The reactions of the children in the two situations were rated on a
dozen categories: Behavior was rated as extrapunitive when aggression
was directed toward the external world, as intrapunitive when aggression
was directed against the self, and as impunitive when the child tried to
88 Physical Disability — ^A Psychological Approach
avoid blame and aggression entirely by passing over the frustrating situa-
tions lightly. In addition, the behavior was rated according to the degree
to which it showed "obstacle-dominance" (concentration on the barrier
itself), "ego-defense" (defense of the self) and "need-persistence"
(emphasis on solution). Finally the behavior was evaluated in terms of
six variants of ego-defensive scores.
The main overall findings may be summarized as follows: ". . . few
differences exist between the groups in terms of response to frustration.
What differences do appear . . . seem to indicate a consistent tendency
[though slight] for the hard-of-hearing children to meet frustration more
constructively than the non-handicapped children" (p. 58). Specific results
are:
1. There is a negative correlation between hearing loss and ego-defensive
responses (r = —.34), as well as between hearing loss and obstacle-dominant
responses (r = —.24), but the correlation between need-persistive responses
and hearing loss is positive and significantly high (r = .37).
2. As for the direction of blame, externally aggressive responses are posi-
tively related to hearing loss, while internally aggressive and impunitive re-
sponses bear a negative relation to hearing loss. The most severely handicapped
children tend toward greater use of extrapunitive responses. When confronted
by the "realistic" frustration situation, the hard-of-hearing children are likely
to abandon extrapunitive responses in favor of responses which indicate that
they accept responsibility for failure. Such response tendencies seem to indicate
that the hard-of-hearing children meet frustration with a realistic acceptance
of the extent of their responsibilities.
3. The evidence strongly suggests that unwarranted suspiciousness (as
manifested in undue emphasis on extrapunitive responses) is not an invariable
feature of the hard-of-hearing child's personality.
4. Hard-of-hearing children do not have lower thresholds for frustration.
The findings taken in toto may reasonably be accepted as an indication of at
least average emotional maturity of these children so that as a group they can
be expected to have "sufficient emotional reserve to withstand and overcome
the adversities of the deprivations inherent in their handicaps" (p. 64).
A second study dealing with the management of frustration as related
to disability was carried out by Fitzgerald (1950). Initially, the line of
reasoning that guided the research was: (1) limitation of normal mobility
and activity implies the presence of a frustrating situation; (2) increased
frustration, according to the frustration-aggression hypothesis, results in
an increased tension state (see Dollard, et al., 1939); (3) therefore, the
reactions of the crippled might be expected to deviate from normal because
of increased tension. Thirty adolescents with moderate to severe crippling
conditions and a comparable group of nondisabled young people served as
subjects.
Frustration and Uncertainty 89
Contrary to expectations, reaction to frustration, as established by
behavior with difficult form boards, was not differentiable on grounds of
physical status. Instead, the investigator concluded on the basis of inter-
views with the subjects that the ability to perform a task under stress is
more closely related to personal feelings and attitudes about home than
to status as a physically handicapped or physically normal adolescent.
Thus, subjects who felt dissatisfied with their home life did more poorly
than those reporting fewer deviant home conditions. The experimenter,
however, retained the frustration-aggression hypothesis as applied to dis-
ability by his interpretation of the following findings: the male but not the
female subjects with crippling conditions tended to reveal lower aggressive
urges and sadder feeling tones in stories (elicited by use of the Thematic
Apperception Test) than did their nondisabled counterparts. He hypoth-
esized that the male adolescent who has a disability is frustrated in his
ability to carry on the usual masculine role and consequently inhibits the
feeling of aggression, expressing it instead as states of unhappiness. This
same resultant would not hold true for females, since a physically de-
pendent status does not conflict as markedly with the feminine role.
The fact that these two well-executed studies did not show subjects with
disabilities either to have lower frustration thresholds or to react less ade-
quately to frustrating situations than their nondisabled counterparts forces
one to reexamine the common-sense coimections between disability and
frustration.
Evaluating the First Common-Sense Notion
The first assumption that must be considered is that persons with dis-
abilities are more frequently frustrated than the nondisabled. The few
available studies, however, actually belie the generality of this assumption.
Shere (1954) studied the parent-child relationships of 30 pairs of twins,
one of whom in each pair was a cerebral-palsied child. The pairs included
10 pairs of identical twins, 9 pairs of like-sex fraternal twins, and 11 pairs
of boy-girl twins, ranging in age from V/a to 16 years. The disability of 12
of the cerebral-palsied twins was judged to be mild to moderate, nine
considerable, and nine extreme. This study is one of the few systematic
twin studies found in disability research.
The following findings, based on several rating procedures, are relevant
to the present discussion. They are statistically reliable at the 5 percent
level of confidence, which means that in only five cases out of 100 would
they be expected to result from chance.
The behavior of the parents toward the twins differed only in certain areas.
90 Physical Disability — ^A Psychological Approach
They tended to be more understanding of the potentialities of the cerebral
palsied twins and to get along with them with less friction.
They tended to expect the twin not cerebral palsied to assume more responsi-
bihties and to act in a more mature manner than their age or capabilities
would warrant.
Moreover, the parents appeared to be aware of the problems of the cerebral
palsied child but to be oblivious to those of his twin.
It is believed that the lack of conformity exhibited by the twin not cerebral
palsied and the consequent disciplinary friction with the parents was part of
the behavior pattern of the rejected child.
In other areas the behavior of the parents was actually more desirable
toward the child not cerebral palsied than it was toward his twin.
The child not cerebral palsied was accepted in an objective matter-of-fact
way, accorded a place in all family activities, given help when necessary, pro-
tected from real dangers, encouraged to participate in new activities, and
allowed to govern his own activities as much as possible.
On the other hand, the parents tended to overprotect the cerebral palsied
twin; to prevent, consciously or unconsciously, his growing up; to give him
little or no active part in forming family policies; to direct his activities in a
loving but usually arbitrary manner.
The behavior of the twins differed. The child not cerebral palsied was more
curious, more ready to explore than was his cerebral palsied twin.
However, the latter was more cheerful and less stubborn and resistant to
authority.
He was less easily excited and less prone to violent emotional outbursts.
He was more willing to wait his turn without becoming impatient.
He was not as sensitive to either flattery or disparagement as his twin and
was not unduly jealous.
This list leads to the important conclusion that, among these children,
those with cerebral palsy experienced fewer frustrations in their relation-
ships with their parents than did their nondisabled twin. We must remem-
ber, of course, that the subjects were still children, and whether the benign
environment will persist in adulthood is uncertain. Also, how the children
fared outside the home was not investigated in this study.
The ecological study by Barker and H. Wright (7955) is even more
startling in its findings, for it covers naturally occurring situations both
inside and outside the home. The three findings most pertinent to the topic
of frustration are based on behavioral observations throughout a day in
the lives of 12 nondisabled children and 4 children with appreciable dis-
abilities. The children were between 2 and 1 1 years of age. The number
of children is small, but the consistency of the findings and their theo-
retical implications give them an importance of the first order.
1. For each of the children, there was a relatively low frequency of episodes
ending in success, frustration, and failure. Summing the percentages for these
Frustration and Uncertainty 91
three experiences yields a median of 2 percent for the group. Thus, "life for
these children appears to have been less a matter of high ups and low downs
than one might be led to expect from the amount of attention often given to
these outcomes of action in research and writings on children's behavior" (p.
298). (The rating "success" was reserved for episodes in which there was
clear evidence of pride in having accomplished something difficult. Satisfaction
in goal accomplishment without especially crediting the self was rated as
"attainment," or as "gratiiication" where credit was bestowed upon another.)
2. For every child the percentage of good endings (attainment, gratification,
and success) is higher than the percentage of bad endings (nonattainment,
frustration, failure).
3. There is no suggestion of difference between the nondisabled children and
the children with disabilities; a contention that motor disability necessarily
implies more frequent occurrence of bad episode endings is simply not sup-
ported.
The far-reaching implications of these findings and of some comple-
mentary ones are conveyed in the following major conclusion: "The out-
come of behavior episodes in so far as it is related to release of tension,
success, failure, frustration, etc., is in children virtually unrelated to motor
and intellectual abilities. The fact that the 2-year-olds and the 10-year-
olds, the physically disabled and the normal children were perceived to
experience the same episode outcomes would seem to indicate that some
governing apparatus is functioning to protect the weak and disabled from
too great [negative] psychological consequences of their limitations" (p.
465).
The protective governing apparatus may be placed within two foci —
namely, environmental accommodations on the one hand and adjustive
changes within the person on the other. Examples of the former are:
considerations in the home that take into account the special needs of
each person, school curricula geared to individual and group differences,
architecture that accommodates the varying physical attributes of people,
legislation on behalf of persons with disabilities. These are frustration-
reducing accommodations. Of course, the social environment, through
mistaken notions or even through "malice aforethought," can make life
for persons with disabilities unnecessarily frustrating. How the positive
and negative envirormiental factors balance out can be expected to vary
to some extent with times and places. Nevertheless, it seems certain that
the environment is benign more often than our fears would allow, though
to be sure it is also more deleterious in many instances.
In addition to environmental accommodations are the adjustive changes
within the person. The person does not simply remain in a frustrating
situation "taking it on the chin." Varying reactions to frustration have
been discussed elsewhere (Rosenzweig, 1938), but here we can note that
92 Physical Disability — A Psychological Approach
considerable learning often takes place in coping with frustration. The
person learns about the sources of the frustration, what he can and cannot
do, the nature of the physical environment and its human inhabitants, all
of which are important differentiations of his reality.
One of the general consequences of such learning is that he adjusts his
goals (usually referred to in this context as the level of aspiration) to his
experience of success and failure. With success, his aspirations usually
rise; with failure they decline. To be sure, this balancing mechanism of
the level of aspiration may be counteracted by other factors (see p. 337
and Barker and Wright, 1952), but it is certainly not typical for a person
to continue to concentrate on unattainable goals.
Besides lowering one's goals in accord with one's abilities, the person
may meet frustration by substituting a goal that is attainable and that in
effect brings about the same satisfactions. This implies that essentially the
same need may be satisfied by means or subgoals of entirely different
character. For example, when the person is unable to participate success-
fully in sports, he may substitute goal activities that do not require physi-
cal agility and still enjoy the satisfaction of such broader needs as that
of group belongingness or achievement.
Still another constructive reaction to frustration, similar to the former
in some respects, is to find a way to circumvent the difficulty, to discover
new ways to accomplish the task at hand. This restructuring of paths to
goals is seen in process when Wally, unable to push his wagon straight up
the incline, turns it at an angle and with the help of other adaptive
maneuvers, achieves his goal. For a recording of this incident see pp.
5-6.
The pendulum must not, of course, swing from the position where dis-
ability is equated with frustration to the opposite, where frustration is
never seen to stem from disability. The following incident, one of many
that could have been selected, shows that (1) the person is unable to
reach his goal because of limitations imposed by his disability and (2)
the totality of circumstances makes it difficult to alleviate the frustration
by a shift in goals or in means. It is the same 4-year-old Wally whom we
met trying to push his wagon up the bank. He is unable to walk because
of a polio attack a few years before. The scene is a backyard shed where
he and his cousins, Ben and Jim, ages 6 and 8 respectively, are playing :
Both Jim and Ben were on an old auto seat in the southwest corner of the
shed. Between that and the doorway where Wally was, lay quite a bit of debris,
including some heavy electric wire.
Ben said invitingly and commandingly, "Come and get on this, Wally,"
meaning on the auto seat. Wally paid no attention to them but crawled away
toward the door from the shed into the Wolfson's garage.
Frustration and Uncertainty 93
Ben came to Wally and said shortly, "I'll carry you." He picked Wally up
under the arms and proceeded to drag him across the debris and wire to the
auto seat.
As he squirmed, Wally protested loudly, "I don't want over there." Wally's
reluctance seemed just to make Ben more insistent. He dragged him over and
dumped him on the end of the auto seats.
Wally, with impotent anger, said, crying as he said it, "Take me back, I
don't want over here. Take me back."
Jim said in a lofty and quite nasty way, "You can take yourself over. You
can take your own self over."
This enraged Wally. He shouted, "You big shit-ass, you. Goddarrm it, you
take me over."
Ben and Jim joined forces and taunted, "Take yourself over."
Wally, whipped into a frenzy, yelled, "Goddamn it," again. "You will take
me over."
The two boys together teased, "No. Take yourself over."
Wally slipped off the end of the auto seat. Crying and shouting, he tried to
make his way back to the shed door, crawling over the debris. He got entangled
in the heavy electric wire that was in the way.
Jim and Ben took hold of the wire and pulled on it to pull him back. One
of them said playfully, "We've got a big fish on this wire.*^
Wally took hold of the wire but his strength was not sufficient to counter-
balance that of the other two boys. He was in a frenzy. "Goddamn you," he
yelled, angry and crying.
He fumbled around, evidently for something to throw at the boys. Wally
picked up a corn cob and threw it at them as hard as he could. One of them
immediately threw it back at Wally. Wally threw another com cob. They threw
one back at him. Jim and Ben were teasing Wally; they were not angry.
Wally was really angry and obviously wanted to throw something at them to
hurt them. He got hold of the handle of the big ax. He said fiercely, "I'll throw
this at you," as he tried to lift it. It was too heavy for him to really lift
adequately.
Ben immediately, recognizing Wally's real anger, came and took hold of the
ax and pulled it away from him.
Wally picked up a piece of a bushel basket that was broken and threw that at
the boys but didn't hit them. Then he found a short heavy board and pulled it
up and started to throw it at them.
Ben came and easily took that away from him.
Wally pulled himself loose from the wire. He crawled over to the doorway
and got out of the door, crying and whimpering as he crawled toward the
kitchen door.
His mother appeared at the kitchen door. I [observer] heard him call to his
mother from the ground, "They've been teasing me," complaining bitterly
[Barker and H. Wright, 1948-19511^
^ One of a series of records.
94 Physical Disability — A Psychological Approach
That Wally was frustrated to the point of tears and that he could do
Httle about it is clear. It is also clear that if he were sound of limb he
could have run away and have avoided much of the unbearable frustra-
tion that ensued.
In analyzing this incident more specifically, the problem of attribution
clearly arises. To be sure, Wally's limitations prevented his escaping the
ordeal, but there was no doubt in his mind that the behavior of Ben and
Jim was the source of his misery. That is to say, though the disability was
one of the factors that made the situation a frustrating one, it was not
viewed as the causal condition. The importance of source or causal
attribution to the meaning of an experience of frustration has been
stressed by Heider (1944). He points out that "usually frustration leads
to aggression only (and not always even then) when the origin of the
frustration is attributed not to one's own person, or to impersonal causes,
but to another person" (p. 367).
For the sake of completing the picture, however, it is necessary to add
that there are many times when a disability may be held responsible for
one's failures. Sometimes this belief may actually be the case and some-
times it serves as a convenient rationalization. In any event, ascribing
failure to the disability may act as an excellent protection against the
greater personal indictment that the failure and frustration were the
resultants of inadequacies of the ego, such as motivation and character,
for which the person is more deeply responsible (see Heider, 7955.112).
The main theme of our discussion is that though a disability may act
as a barrier to the achievement of certain goals, the person in adjusting
to this reality tends to alter his aspirations and way of life in such a way
that oppressively frustrating situations are avoided. Add to this the many
environmental accommodations that take special needs into account and
we can no longer be surprised to find no more frustration in life histories
among persons with a disability than among the nondisabled.
This is not to say, of course, that there are not many persons with dis-
abilities who are frustrated. Unfortunately, the person-environment-
governing apparatus is not foolproof, either for persons with physical
limitations or for those without. The world has all too many persons who
are excessively frustrated, distraught, bothered, unfulfilled. The thera-
peutic focus must then be placed on personality and/or environmental
factors that require change in order to facilitate adjustment.
Why does the common-sense notion that sees in disability frustration
heaped upon frustration persist with such tenacity? The reasons are varied,
but fundamental is man's proclivity to view the situation of another from
his own perspective. Especially when he has no need to do so, it is dif-
ficult for him to see with another person's eyes. In empathy we often
react the way we think we would feel in such a situation without realizing
Frustration and Uncertainty 95
that adjustive forces within our own psychic economy would so alter the
meaning of the situation that the emotional reaction would be corre-
spondingly different.
Thus, in the following scene, as Lila is viewed laboriously building a
tower, probably most persons would feel an "anticipatory" frustration that
in fact was not there at all. Lila is 8/2. Cerebral palsy has affected her
hand and arm movements so that only with a great deal of patience and
persistence does she manage to accomplish tasks requiring fine move-
ments. It took Lila more than two minutes to place the six blocks one
upon the other, a task that could ordinarily be completed by a child her
age in a fraction of the time:
Lila picked up the red block carefully and set it down directly in front of her.
Then she slowly picked up the orange block. She laboriously placed it on
top of the red one.
Lila carefully picked up the yellow block. As she picked it up, it fell out of
her hand. She picked it up again. The yellow block was carefully put on top
of the orange one.
Then she picked up the green block. It took her almost twice as long to put
the green block on top of the yellow one. Finally she got the green one fitted
on top of the yellow one.
She picked up the blue block. She laboriously tried to put the blue one on top
of the green one but the tongue and groove didn't match. She looked at it for
a moment.
Then she slowly took the blue one off. She put it down on the desk. She
turned it around in her hand. Then again she carefully tried to put it back up.
This time she put it on so that it fit securely in place.
She took the smallest block, the purple one, and carefully put it on top.
After a few moments she got it in place.
As soon as she got the block in place, she banged her hand and squealed in
delight [Barker and H. Wright, 1948-1951].^
Lila would have been frustrated only if her goal had been to complete
her task in short order, for then she would have been blocked by her
physical limitations. Instead, the goal itself was molded in terms of the
reality of her situation.
A second reason for the association of disability with frustration has to
do with the fact that the nondisabled person, being uninitiated into the
specific ways of circumventing limitations, tends to perceive the disability
as an insurmountable barrier to the achievement of many goals. For
example, many persons would be certain that the following activities are
closed to those who are blind: playing ball, mowing the lawn, traveling,
roller skating, and so on, until the list becomes frighteningly long. It is
2 One of a series of records.
96 Physical Disability — A Psychological Approach
with surprise and admiration that many learn that none of these activities
is denied, because the manner of carrying them out can be appropriately
modified.
Also, physique as prime mover (see pp. 124—128), the phenomenon
that gives to disability such a central position that it is held accountable
for unrelated events in the life of the person, plays its role in reducing
frustration to the fact of disability. Accordingly, whatever failures and
frustrations the person with a disability may experience tend to be seen
as disability-connected.
Finally, the presumption that disability brings about frustration leads
the observer to expect frustration, an expectation that conditions him to
highlight evidence supporting the expectation and to suppress or distort
facts that conflict with it. This is a case of "selecting the facts that fit and
fitting the facts that do not." We shall meet it again in a discussion of
expectations and the interpretation of social relations (Chap. 7). Through
this selective phenomenon, perception becomes pressed into the service
of one's biases and expectations. Recognizing this danger, Kahn (1951),
in his experiment on frustration in normal hearing and impaired hearing
children, took precautions against it. By deleting the identification of the
subject from the record of behavior in the frustrating situation, the
research workers could rate the behavioral accounts according to frustra-
tion indexes without the biasing influence of their expectations.
The oversimplified linkage between disability and frustration would not
be so disturbing to the person who has a disability were it not for the fact
that often an attitude of devaluating pity accompanies it. Because this
linkage is supported by the common sense of perception and cognition,
it is necessary to bring about understanding through reappreciation of the
basic truth, ignored perhaps because it is so familiar, that life is a process
of adjustment, of mutual accommodations between the person and his
environment.
Evaluafing the Second Common-Sense Notion
The generality with which "frustration" is judged to be a negative
experience makes one realize how natural this evaluation is. Mowrer
(1938) points out that frustration is also a negative term to the clinician
who sees in the life histories of delinquent, criminal, and disturbed persons
relatively severe and persistent frustration as an unvarying antecedent.
Nevertheless, a second look reveals that frustration is an inevitable part of
life and a third look leads to the conclusion that it is capable of leading
to highly desirable as well as to undesirable results.
To begin with, it appears obvious to many psychologists and educators
that learning cannot be achieved without some frustration. If gratification
Frustration and Uncertainty 97
were contemporaneous with the arousal ot desire, the ultimate in frustra-
tion-free situations, the self could hardly be differentiated from the sur-
rounding environment. It is in the solving of problems, not in the ready
acquisition of goals, that insights are attained.
Besides, blocking certain activities releases energy for other purposes.
This is one of the bases for advocating sublimation as a psychological
mechanism important in adjusting to the restrictions of the social and
physical environment. Thus some psychologists, notably psychoanalysts,
hold that sublimating sexual impulses renders the psychic energies serv-
iceable to other endeavors, such as art, science, and creative enterprise in
general, the main problem being to channel the available energy to con-
structive rather than to asocial uses. Undoubtedly there are more or less
permanent renunciations demanded of all members of a group as the
price they must pay for the gains of social living, but these "cultural
privations" may be turned to constructive outlets.
Furthermore, the fact that catastrophe and other unplanned, trying
events do inevitably occur requires that the individual develop a tolerance
for frustration if he is to remain undefeated by them. This tolerance
doubtless cannot arise in the absence of prior experience with frustration.
Rosenzweig believes that frustration tolerance can be fostered by allowing
the child to experience small amounts of frustration — amounts that he
can negotiate without reacting inadequately. Extreme deviations from this
optimal dose will produce difficulty. If the child is overindulged, he will
develop insufficient frustration tolerance. If, on the other hand, he is
frustrated beyond his ability to handle it, areas of low frustration tolerance
or complexes may be created and the ground prepared for behavior dis-
orders (Rosenzweig, 1938:153).
In a significant study on improving children's reactions to failure
(Keister, 1937), the training program was designed to introduce the
children to progressively more and more difficult tasks, thus enabling
them to build up mature and desirable responses to later situations dif-
ficult for them. During the training, the child was encouraged to persist
longer in the face of tasks that were difficult for him, to depend less on
an adult for help, to offer fewer rationalizations in the face of failure, and
to attack a problem with a certain amount of composure. The children
who experienced the training showed marked gains, whereas a comparable
group of untrained children showed little change in their habitual response
to frustrating situations.
Analyzing the effects of frustration from another point of view. Barker
(1938) considered two different kinds of problem: (1) the effect of frus-
tration upon abihty to overcome the difficulty from which the frustration
arises; and (2) the effect of frustration upon ability when an individual
gives up and turns to other activities : in other words, what is the effect of
98 Physical Disability — A Psychological Approach
a frustrated need upon the intellectual level of behavior not directly
related to the satisfaction of that need? In both cases, as Barker points out,
the reaction may reflect either a lowering of intellectual (cognitive)
functioning, as when regression occurs, or it may reflect creative behavior
of a high order.
In the following experiment (Barker, Dembo, Lewin, 1941), for
example, though the typical reaction was one of regression and primi-
tivization, some of the children showed an increase in their level of
constructiveness. Thirty nursery school children were observed indi-
vidually on two occasions: first, in a standardized playroom, where the
child's play was rated by observers on a constructiveness scale; secondly,
when the room had been enlarged and the old toys incorporated into
play materials greatly surpassing them in attractiveness. After the child
became thoroughly interested in the new toys, the situation was changed
to a frustrating one by making them unobtainable by placing a barrier of
wire netting in front of them so that they could still be seen but not
played with. The old toys were available, and play with them was com-
pared with the previous play in the standard situation on a constructive-
ness level.
Barker (1938) makes clear that the constructive level of behavior is
depressed when the person is torn between preoccupation with the goal
he is frustrated in reaching and the goals in which he is currently involved.
Conscious awareness of this double concern is not a prerequisite, for,
though there may be repression of one, conflict still persists.
On the other hand, constructiveness may be enhanced when the
stepped-up tension stemming from frustration is deflected toward other
goals that are able to satisfy the same needs (substitution; in the case of
repressed needs, sublimation), and when it raises the energy level of a
person otherwise only lethargically interested in an available activity (p.
149). In addition, frustration may stimulate the person to new solutions
of his current difficulty. His efforts, however, cannot be so intensely con-
centrated on the goal or its barrier that he becomes shortsighted for lack
of adequate perspective. Rather, along with his persistence, he must
achieve the flexibility that comes with a suflScient degree of relaxation to
enable him to survey alternatives and not be bound to a limited number
of them. Krech and Crutchfield (1948) present a succinct yet compre-
hensive analysis of the sources and consequences of frustration under the
proposition that "the frustration of goal achievement and the failure of
tension reduction may lead to a variety of adaptive or maladaptive be-
haviors" (pp. 50-62).
With respect to the problem of adjusting to disability, it seems to us
that one of the most common and powerful factors militating against
the constructive substitution of means and goals in coping with frustra-
Frustration and Uncertainty 99
tion is what has been referred to as "idolizing normal standards" (see pp.
24-40). If the person feels that he is valued according to the degree
to which his goals and behavior are the same as they would have been
without his disability, then, depending on the limitations imposed by the
reality of his disability, he is a ready candidate for overwhelming frustra-
tion. The following protocol of a counseling session with a 16-year-old
boy suffering from a quadriplegic cerebral palsy shows the depths of
despair that can result from frustration stemming from rigid adherence
to the standards of the nondisabled state :
Subject: "I just don't know why the doctors let me live when I was bom.
I'm no use to anyone the way I am."
Counselor: "You feel that you are of no value to society and that dis-
courages you."
Subject: "Yes, I know what I want to do and I can talk O.K., but every time I
try to do anything I'm stymied. I can't walk or even eat without some help."
Counselor: "You feel, because of your physical condition, that you can't do
many of the things you want to do and you feel frustrated when this
happens."
Subject: "It's worse than that. When I can't succeed in something and when
I know I could succeed if I weren't a C.P. (cerebral palsy), I get more than
discouraged because I'm so helpless. You're stuck and you hate yourself for
being stuck" [Cruickshank, 1948:Sl-82].
Some will hold that in such an extreme case of helplessness overwhelm-
ing frustration is inevitable, and yet we must remind ourselves that it
was this boy's vision of his accomplishments unfettered by his disability
("I know I could succeed if I weren't a C.P.") that was crucial in making
rigid his aspirations so that appropriate modifications could not bring
satisfaction.
Disturbance may be created not only in frustrating situations, where
the goals and the way to reach them may be clear but blocked, but also
in what have been described as new psychological situations. This prob-
lem will be examined before we proceed to a discussion of adjustive
changes within the person which, in enabling the person to live more
comfortably with himself, also bear upon frustration and uncertainty.
UNCERTAINTY ARISING FROM
NEW PSYCHOLOGICAL SITUATIONS
Puzzling over a problem, being on thin ice, applying for a job, being
in an unfamiliar town, entering a social situation well under way, all have
in common the fact that in certain respects the situation psychologically
100 Physical Disability — A Psychological Approach
is a new one. This means that the directions toward a desired goal are
unknown and that the behavior one embarks upon is simultaneously
positive and negative, i.e., each act may place one closer to the goal
(positive) or move one further from it (negative). Such a situation
provokes cautious behavior and, to the extent that the situation is a
dangerous or crucial one, anxiety and insecurity as well.^
Situations that are psychologically new in the sense that they are
perceptually unclear, unstructured, or ambiguous arise in regard to a
person's disability when: (1) the person is unsure as to whether he will
be able to manage physically. (For example, he may not know whether
the building has steps that he must negotiate but that he may be unable
to manage.) (2) the person is unsure of his reception by others. (For
example, he may not know whether he will be accepted or rejected,
shown sympathy or devaluating pity, reacted to with fear or trust, helped
or ignored, etc. See Chap. 9 for many illustrations of this.) (3) the
person is unsure of what kind of person he himself is. (For example, he
may have diflBculty in reconciling his physically imperfect body with
personality characteristics that are acceptable and even complimentary.
See p. 157 for the anguish and the conflict suffered by a young woman
every time her mirror image shattered her self-illusions.)
Whether or not a physical disability in general tends to increase the
frequency with which new psychological situations are encountered
requires ecological investigation. Some psychologists have taken a firm
position that it does (see Meyerson, 1 955b. -48). But relative frequency is
always difficult to establish and depends on many inconstant conditions.
If one argues, for example, that the able-bodied person is not troubled
by unknown architectural features (as whether a building has steps or an
elevator), one can counter that the able-bodied person might more fre-
quently engage in activities that would involve other kinds of uncertain
physical-geographic situations. Whether in greater or lesser degree, none-
theless, the problem of uncertainty resulting from new psychological
situations seems especially prominent in the case of particular physical
disabilities: for example, deafness, blindness, and epilepsy.
The following account shows the extreme consequences of uncertainty
created by seizures that overtake the person without warning:
3 For a more detailed and systematic account of the properties of new
psychological situations, see Barker et al. (1953:30-37), the thinking therein
stemming from the work of Lewin (1936, 1938). The concept of new psycho-
logical situations and their derived behavior, namely, behavior characterized by
conflict, emotionality, alertness, and instability, has been applied to a variety of
cases such as adolescents (Lewin, 1939; Barker et al., 1953), autocratic groups
(Lippitt, 1940), and persons with disabilities (Barker et al., 1953; Meyerson,
1955b).
Frustration and Uncertainty 101
When I have an attack, I sort of go into my shell. I stay at home, am absent
from school and just sit around thinking. I am afraid that I might get another
attack any minute. When a few days have passed since my attack, I may go
out of the house, perhaps for a walk. But I am still very anxious about my
physical condition and make sure that I get home quickly. It takes about a
week before I feel like returning to school and seeing outside people. Even
when I'm back at school I can't help thinking about getting an attack there, or
in the street or in the subway. It seems as if I'm always ready to jump within
my shell, as I Uke to put it, at the slightest disturbance [Arluck, 1941:64—65].
In this case, the persistently "new" psychological character of the
person's surroundings was not due to his never having experienced them
but to his inability to structure his situation in a stable way because at
any moment events could shift dangerously beyond his control. The
tension, caution, conflict, frustration, alertness to every cue — behaviors
derivable from the forces characterizing new psychological situations —
are apparent. Whenever a situation occurs in which the consequences of
behavior are seemingly unpredictable or uncontrollable, and in which
benefits and harms occur in an apparently inconsistent, fortuitous, or
arbitrary manner, insecurity of the deepest sort may be expected. The
fact that most persons with epilepsy, however, are able to control seizures
with proper medication means that they need not be beset by insecurity
stemming from unexpected physical attack. Nonetheless, uncertainties of
social reception as well as ambiguities resulting from an unstable self-
image (for example, one that vacillates between identification with the
healthy and with the sick) may give to the life space the character of
frequently occurring new psychological situations (Lewin, G., 1957).
It is most important to distinguish between unknown situations that are
difficult to avoid, as in the case of uncontrollable seizures, and those that
arise because the person himself has not accepted his disability. Much
uncertainty and tension stem from the fact that, in hiding his disability,
the person at the same time prevents clarification of his behavior possi-
bilities (see pp. 48-49). The overwhelming anxiety that can be self-
imposed in this way is seen in the account by Raymond Goldman, who,
hard of hearing, could not tell when the teacher would call upon him or
what point in the text the recitation had reached (see pp. 31—32 for
incident). If only Raymond had allowed himself to inform the teacher of
his hearing difficulties so that appropriate steps to meet them could have
been taken, he would have been spared much of the uncertainty of a
perceptually confused situation. For example, he could have been placed
in a strategic position to speech-read more adequately; someone could
have followed along in the text with him, and so on.
That the uncertainty of new psychological situations faced by a person
102 Physical Disability — A Psychological Approach
with a disability is frequently independent of the fact of his disability also
must be recognized. Because the following incident clearly illustrates this
and because it also demonstrates a type of behavior commonly occurring
in new psychological situations, it is recounted in full. Karsten tells about
the time he and a girl, both blind high school students, were out together
for the first time. Especially prominent is cautious, exploratory, trial-and-
error behavior. Underlying tension and resulting frustration may be
presumed.
... I found a small brick alcove jutting out from the wall with a high con-
crete step at its base. I brushed the snow from a small area, and we sat down
on either side of it about three feet apart. The girl was a bit timid, I thought.
For a long time we sat in silence. Snow settled on my hat. The cold air pried
into my overcoat and through my shirt. I rummaged about in my brain trying
to find something to talk about.
"It's kind of cold out tonight," I said finally.
The girl drew her coat more closely about her.
"Yes," she said, her head still turned straight ahead.
I shivered. I turned up my collar and wished that I had put on my winter
underwear.
"I think it will be warmer tomorrow though, if it doesn't turn colder," I went
on. Words came out of me like a dull razor sawing through dry whiskers. The
girl took a handkerchief from her purse and blew her nose cautiously.
"Yes," she said.
I had a vague feeling that things were not progressing. I put my hands in
my pockets and curled my toes, trying to find a warm spot by the heel. There
must be other interesting subjects that we could talk about!
"You live quite far from here, don't you?" I asked.
She deliberated.
"Yes," she said.
I was uncomfortable. I managed to keep some warmth in my hands and feet,
but the concrete I was sitting on did not seem to warm up at all. We sat staring
into the snow. The girl moved uneasily, but I said nothing. It was her turn to
ask questions. I did not want to hog all the conversation. Snowflakes clattered
loudly on the crown of my hat. I wondered what Ben and his girl were talking
about on the other side of the building. My companion blew her nose again and
turned slightly.
"Do you like that new song we are learning in chorus?" she asked.
I fumbled about for a brilliant answer. Our conversational infant needed a
verbal whack that would put life into him.
"Yes," I replied.
She deliberated again.
"I think the sopranos sing a little flat, don't you?"
"Yes," I said.
We lapsed into another long and profound silence. My thoughts moved
sluggishly, like broken ice on a prairie river. It was getting late. In a short time
I
Frustration and Uncertainty 103
the girls would have to leave. Impulsively I put my hand on the concrete
behind her back and leaned forward.
"My lips are kind of puckery tonight," I said nonchalantly.
"Are they?" she brightened. Her voice was like chocolate and raspberry jam.
She leaned toward me. Her face was not over two feet away. "What do you
suppose makes it?" she asked.
I took my hand from behind her back and turned the other way again.
"I don't know," I said, rubbing my hps reflectively. "Been practicing too
much on my comet, I guess. . . ."
We were half buried in snow when Ben and his girl came around the comer
again. When the girls were two blocks or more away, Ben and I started trudging
slowly along. Ben was silent. I wondered what he was thinking of — most likely
of all the things he and his friend had talked about.
"What sort of a girl was she, Ben?" I asked.
Ben plodded along.
"Yes," he said hollowly.
I waited. He seemed unaware of my presence.
"I said: 'What sort of girl was she?' "
"Yes," Ben repeated mechanically.
I shook my head sadly and blew a cloud of steam inside my collar to thaw
my cheeks. Together we trudged along over the drifts toward home [Ohnstad,
7942;146-148].4
Situations that are psychologically new differ from one another in an
important respect: some are crucial and even dangerous to the person and
some are not. Being on thin ice, either literally or figuratively, is an
example of a new and dangerous psychological situation. Working through
a problem in automobile mechanics or in room decorating is an example
of a new but relatively safe psychological situation. It is safe even though
the directions to the goal are unknown and even though one is bound to
make false steps in spite of caution. The safety accrues either from the
fact that the inevitable false steps are reversible or because the worst
eventuality, failure, is not crucial to the security of the person. As applied
to disability, this means that a psychologically new situation may, with
adjustment, shift from one that spells danger to one that is far more
innocuous.
First, as to the matter of reversibility. The person can develop facility
in structuring otherwise unknown situations. If he has a hearing impair-
ment, for example, he can ask people to face him, to speak louder, to
repeat. If he is blind, he can begin to use a white cane or ask someone to
accompany him when he goes to town the first time. Obviously, these
* Karsten Ohnstad, The World at My Fingertips, IndianapoUs, The Bobbs-
Merrill Company, 1942. By permission.
104 Physical Disability — A Psychological Approach
facilities are not independent of the person's acceptance of his disability,
which, as we shall see in the following chapter, is contingent upon im-
portant changes within the value system of the person.
As for the matter of how crucial the situation is, this too, in many
instances, is subject to reevaluation. For example, if the person's self-
esteem hinges on whether he can converse like any normally hearing
person, on whether he can find his way around town unaided, on
whether he can walk as far as the next man, then these situations are
crucial and any perceptual unclarity will give rise not only to cautious
behavior but to anxious behavior as well. But if, as a result of adjustive
changes, he is able to accept his limitations, then failing to keep up with
the others is simply not decisive to his ego. He may remain alert as to
how he can best manage, but the emotionality of conflict and frustration
need not be prominent accompaniments.
It is not so much the situation that is psychologically new as such that
one wants to avoid (though to be sure a superabundance of such situa-
tions with the problem solving required in them may become burden-
some). If all situations were well structured — that is, if the directions to
goals were always known — man would neither be alerted nor challenged
to make new discoveries. Probably the notion of optimum balance be-
tween the known and unknown is applicable here. But it is true that the
psychologically new situation that is also a major threat to the person
ought either to be avoided or altered where possible unless some purpose
is served by entering it.
In this chapter, frustration and uncertainty as problems commonly
associated with disability were briefly examined in terms of their sources,
certain positive and negative aspects of their consequences, and the condi-
tions that mitigate their deleterious effects. The common-sense notion that
oppressive frustration is a probable if not inevitable accompaniment of
disability has been challenged by a review of pertinent research findings
and theoretical considerations. Environmental accommodations and
changes within the person must become the two foci in understanding
how frustration as a problem-solving situation is often met satisfactorily.
One of the main impediments to the adequate solution of frustration-
producing situations as far as disability is concerned is the high value
placed on "normal" standards of behavior. Likewise, diminishing or even
eliminating the danger in many new psychological situations is at least
to some extent within the power of the person himself on the one hand
and of the group on the other.
The main attitude or value changes that have positive adjustive effects
are discussed in the following chapter. These apply not only to the person
Frustration and Uncertainty 105
with a disability, though the focus of the discussion has been placed
there, but to the nondisabled person as well. Specific suggestions as to
how the "other person" may avoid difficulties in ordinary relations with
a person handicapped in some way are presented in Chapter 9.
5
Chapter
Value Changes in Acceptance
of Disability
We have seen how a person who feels ashamed and inferior be-
cause of his disability avoids identification as a person with a disability.
By keeping his disability to himself, he tries to prevent it from becoming
a social fact, hoping that thus he will not suffer rebuff from others and
society. In one sense he is correct in his basis for this course of action for,
having a disability, he will be ill received by some persons and meet
discrimination in some situations of possible importance to him, as, for
example, in employment. By hiding his disability, then, it seems possible
to avoid these negative experiences. If it is not possible actually to conceal
the disability, then the person, as long as he himself feels inferior because
of it, tries to act as though the deviation makes no difference, tries to
outdo himself in maintaining normal standards, and in general tries to
appear as much like a nonhandicapped person as possible. But, even
should he be able to conceal his disability, he cannot in his own eyes feel
the security of being a complete, worthy individual, for admission that a
difference exists is a prerequisite to the further step of accepting the dif-
ference as nondevaluating.
If, as was already shown, the cultural attitudes toward atypical physique
are conflicting, viewing it on the one hand as a sign of inferiority, and on
the other hand as neutral or even as an indication of virtue and goodness
meriting special reverence, why is it that the person with a disability
focuses on the personally more devastating side of the conflict? It is just
because the first view is such a threatening one that it demands a hearing.
And when in this hearing the individual in some way associates disability
with punishment or idolizes the normal ideal, he receives confirmation of
his dreaded feelings that disability is and ought to be a sign of inferiority.
Moreover, as we shall soon see, under certain conditions an inferior
position on one characteristic tends to spread to other characteristics and
to the total person. These and other factors taken up 'n Chapter 10 con-
tribute to the upper hand that disability-as-personal-inferiority assumes
106
Value Changes in Acceptance of Disability 107
at first and that determines the more primitive efforts of escaping the
intolerable rejection of the self.
The maladjustive reactions to disability, however, are important first
efforts in the process of accepting one's disability and oneself. Gradually
and intermittently, the individual may become aware of the strain that
nonacceptance of his disability imposes, and of how, in spite of all his
efforts to the contrary, his deviation is real and has personal and social
effects. Frances Warfield (1948), who admitted her hearing loss only to
her medical and quack therapists, who devised elaborate schemes to hide
her impairment, at the same time perceived well the foolishness of such
acting when the actors were other people. She spoke of them as "sUly
ostriches . . . who didn't fool anybody but themselves" (p. 26). It may
take a longer time and a deeper personal upheaval to admit the foolishness
in oneself, for the admission carries the obligation of altering one's
behavior, of giving up the methods one wants desperately to succeed, of
examining anew the values one holds dear and by which one lives. This
chapter wUl deal with the kinds of value change that appear significant in
the process of accepting one's disability and oneself.
WHAT KIND OF ACCEPTANCE?
The importance of accepting oneself has become a cardinal principle
among psychotherapists ever since the far-reaching role of such psychologi-
cal processes as repression and guUt have become more clearly understood.
Unfortunately, the concept of acceptance has also become a ready-
made cliche purporting to guarantee adjustment, though if one becomes
serious about the connection in the particular context, one often wonders
what kind of acceptance and what kind of adjustment are meant. When
a patient in psychotherapy becomes aware of his hostile feelings and
defiantly begins to insult his associates and cater almost exclusively to his
own needs, is that accepting himself? At the moment he may be accepting
his hostile feelings, but he is also accepting the premise that they need no
controls and that "he is as he is and is fine." Does acceptance require that
the status quo be supreme and sublime, that changes in and about oneself
are unnecessary? We think not.
When a person accepts his state, it does, however, sometimes mean
that he prefers it, that if it were his to choose, he would select it over
other alternatives. There certainly are persons among underprivileged
racial and religious minority groups who are glad that they are Jews or
Negroes or Indians, for example, who wish their children to continue to
be, who accept their group membership in this sense. The book It's Good
108 Physical Disability — A Psychological Approach
to Be Black culminates in the young Negro girl's conviction that she could
be proud that she was black (Goodwin, 1953). Moreover, she felt
"genuinely sorry for everybody in the world lighter than the brown pair
of . . . shoes laced on my dancing feet" (p. 256). Perhaps the opinion
that a person with a disability may be glad about his condition will be
viewed more dubiously. But even this can be the case, and before we rest
comfortably with the diagnosis, "Aha, secondary gain, rationalization" we
must again remind ourselves of the blinding force with which our own
values prescribe our evaluations.
In any case, the problem of acceptance as dealt with here is not con-
cerned with the conditions that will bring about preference of one's own
state over others. Nor does it deal with the other end of the scale, that of
acceptance in the sense of resigning oneself to the inevitable. Resignation
connotes a bowing to misfortune, patiently uncomplaining, rather than
feeling all right about it. We are more concerned with the conditions
facilitating acceptance of one's disability as nondevaluating. The disability
may still be seen as inconveniencing and limiting. The person may still
strive to "improve the improvable" where improvement will facilitate
certain aspects of his life. He may exercise daily to graduate from crutch-
walking to cane-walking, but he will not abandon his crutches pre-
maturely in order to be as much like a normal person as possible. He
will not feel debased as a person and suffer the strain and shame of hiding
and pretense.
Dembo and co-workers {1956) have made a careful beginning in
tracing the process of what they have called "acceptance of loss." By loss
is meant the absence of something valuable, felt as a personal misfortune.
The following discussion is a development of their analysis of the changes
within the value system of the person that are instrumental in overcoming
the feeling of shame and inferiority resulting from disability as a value
loss. These changes may be designated as: (1) enlarging the scope of
values, (2) containing disability effects, (3) subordinating physique, and
(4) transforming comparative values into asset values. These value
changes are interdependent in the sense that affecting one will affect
another, but for clarity they will be considered separately.
ENLARGING THE SCOPE OF VALUES
Enlarging the scope of values means the emotional realization of the
existence of other values. This is of especial importance during the period
of mourning following the loss of something cherished, whether the loss
be physical normality, a loved one, or something else.
Value Changes In Acceptance of Disability 109
Conditions Underlying Mourning
The psychological shock reaction to physical impairment has been
described as a period of mourning comparable to that of bereavement
(Dembo et al, 1956; Cholden, 1954; Blank, 1957). The aptness of this
designation becomes apparent when one realizes that the conditions under-
lying mourning are similar in both instances. It has also been observed
that the blind sometimes refer to their "dead eyes" and the deaf to their
"dead ears" (Blank, 1957:12).
One of the most pervasive conditions producing mourning is the in-
ability or unwillingness of the person to sever ties with the endeared
state that was. By mourning his loss, he brings the past into the present and
in this way does not give up the past.
The person also needs time to begin to absorb the new changes about
himself into his self-concept. As Blank has pointed out, the shock reaction
to loss ". . . seems to be an emergency defense against the threat of
dissolution of the ego by eruption of overwhelmingly painful affects. The
aflfects are thereafter allowed to emerge bit by bit so that they can be
handled by the ego piecemeal . . ," (p. 11).
In addition, a perceptual factor contributes to the persistence as well
as existence of mourning. In the sheer act of comparing the present with
the past, one is prone to attend to the changes and to ignore the common
denominators. Perceptually, the things that are different stand out and
the remainder, in its sameness, becomes obliterated. In the case of dis-
ability, the difference is the disability and thus the loss is seen as the main
feature of the new state.
A person with a disability feels his loss in terms of personal and social
satisfactions now denied him (Dembo et al., 1956) . Mourning for personal
loss is expressed in the following ruminations as Harold Russell (1949)
realizes for the first time that he has no hands :
I looked up and saw my arms. For the first time. Their ends were wrapped
in bandages. They were pulled up over my head and fastened to a wooden
frame above the bed. I couldn't move them. I could hardly move my body at
all. It made me think of the days before I went to the Army, when I worked
in the market. My arms reminded me of two sides of beef hanging on
hooks. . . .
Then it hit me.
It was my hands that were gone. Those things at the end of my arms. Those
things with five fingers on them. They hadn't been much to look at. Quite ugly,
in fact, and dirty most of the time.
Suddenly I knew how useful those hands had been to me. I had always taken
them for granted. Like my eyes, legs, ears, tongue. They had always been
there when I needed them, ready to work. If I wanted to cut and weigh a piece
1 10 Physical Disability — A Psychological Approach
of meat, if I wanted to drive a golf ball, if I wanted to write a letter to Rita or
pull the ripcord of a parachute, they were always there to serve me. I never
had to ask, Will you do this for me? They were always there, by my side,
prepared, willing, unhesitating, obedient, loyal. A pair of stout, strong friends,
not beautiful, but dependable. . . .
I tried not to think about them. . . .
But I kept coming back to my hands. I couldn't get them out of my mind.
What wonderful, efficient machines they were. Hands. So simple. Just some
bones, muscles, nerves, blood vessels and skin. Nothing to them, really. And
yet, how valuable, how perfect, how cunningly contrived to do so many
marvelous things. Like pitching a ball or painting a picture or caressing some-
one you loved [pp. 4-5].^
The social loss content of mourning may be conveyed in the follow-
ing: "People might stand my presence but not accept me as they used to."
"I never had to depend on others. Now I will be a burden." "People will
pity me." "Others will go ahead while I will be left behind."
In mourning, the loss aspects dominate the emotional stage. In extreme
bereavement, "the loss seems to pervade all areas of the person's life.
Whatever he thinks about, whatever he does, he is troubled, pained, and
distressed. There is no differentiation between areas of the person which
are and are not injury-connected. All that matters are the values affected
by the injury and they are lost. No other values in life are important or
even existent" (Dembo et al., 1956:36). In the grip of such an emotional
onslaught, the person may become apathetic, numb to all conscious feel-
ing. Goldman (1947) captures the essence of this state in his recollection
of the period following the death of his wife :
... I tried not to look back; I couldn't look forward, for ahead was a wall
of blankness. It is difficult to put into this chronicle the record of my emotions.
I seemed to have none; I was empty as a wormed shell. I no longer felt even the
twisting pain of grief. . . .
... I wanted to die ... to be rid of the galling burden of futile struggle.
The thought of taking my own life never once entered my mind. . . . Just pas-
lively I wanted to die [p. 168]. 2
Pearl Buck (1950), upon learning that her retarded child could nevei
be normal, was overcome with a despair so profound that it threatened
to destroy her thought and feeling:
1 Harold Russell with Victor Rosen, Victory in My Hands, copyright 1949.
Used by permission of the publishers, Farrar, Straus, and Cudahy, Inc.
2 The selection from R. L. Goldman, Even the Night, copyright 1947, The
Macmillan Company, is used with the permission of the publisher.
Value Changes In Acceptance of Disability I I I
. . . there was no more joy left in anything. All human relationships became
meaningless. Everything became meaningless. I took no more pleasures in the
things I had enjoyed before; landscapes, flowers, music were empty. Indeed, I
could not bear to hear music at all. It was years before I could listen to music.
Even after the learning process had gone very far, and my spirit had become
nearly reconciled through understanding, I could not hear music. I did my
work during this time: I saw that my house was neat and clean, I cut flowers
for the vases, I planned the gardens and tended my roses, and arranged for
meals to be properly served. We had guests and I did my duty in the com-
munity. But none of it meant anything. My hands performed their routine. The
hours when I really lived were when I was alone with my child. When I was
safely alone I could let sorrow have its way, and in utter rebellion against fate
my spirit spent its energy [pp. 29-30].3
Black despair may also occur in the recently injured person when the
experience of loss and change from one's former state is so overpowering
that the suffering seems boundless, not only in extent but also in time.
Then the idea of suicide may present itself or, more moderately, the gnaw-
ing feeling that one's present state is worthless. This period in the case of
blindness has been described as follows :
The shock [of sudden blindness] consists of depersonalization followed by
depression. The depersonalization usually lasts two to seven days. The patient
is immobile, or almost so, facial expression is blank, there is a generalized
hypoesthesia or anesthesia, and mutism [,] or speech is meager, slow, muted.
Superficially, the condition may resemble catatonia. But the patient does not
utter the delusional or dissociated remarks of a schizophrenic; rather, he is
likely during the acute stage, or more often later, to say that he has no feeUng
or that he feels as if he were unreal or the world were unreal. . . . the depres-
sion which follows may be an acute reactive depression or an agitated depres-
sion . . . and it is a state of mourning for the loss of the eyes [Blank, 1957:11-
12].
Mourning may also express the need to make a public pageant of grief.
This may be associated with a bid for sympathy, indulging in self-pity, or
fulfilling the formal requirements of propriety.
That the mourning reaction to loss, though common, is not the only
reaction is seen in a study of World War II amputees (Randall, Ewalt,
and Blair, 1945). It was found that severe depression (mourning) was
the preponderant reaction immediately following the injury in the case of
noncombat casualties, but in the case of battle casualties the modal
reaction was the feeling of being lucky, with depression, though common,
3 Reprinted by permission of Harold Ober Associates. Copyright, 1950, by
Pearl S. Buck.
112 Physical Disability — A Psychological Approach
taking second place. These results can be accounted for by the likelihood
that the battle casualties felt that they easily could have been worse off;
instead of comparing their present injured state with their previous able-
bodied st?ile, the comparison was with their anticipated annihilation. The
difference that stands out in these circumstances is not the loss aspect of
the new state but rather its gain. The percentage of cases (76 battle
injuries, 24 noncombat injuries) reacting variously to injury as determined
by social histories from Red Cross files, Rorschach "blind" analysis, and
psychiatric t.\aminations follows:
Immediately
Following Injury
In Base H
ospital
Battle
Noncombat
Battle
Noncombat
Shame
0
0
II
33
Self-pity
1
0
9
0
Lucky
42
0
7
0
Worry about family
16
13
0
0
Dopression
30
61
13
21
Pcychiatric
4
13
3
8
Mo emotional
response
7
13
57
38
The reaction of the battle cases is more favorable in both phases. In the
second phase the feeling of both "lucky" and depression decreases, and
the feeling of shame and self-pity increases. Finally, it is apparent that
depression was not the only prominent reaction. How many of the "no
emotional response" reactions can be considered symptomatic of what we
have called mourning is not known. An important study of the conditions
underlying various psychological reactions to the stress of surgery (other
than amputation, e.g., appendectomy, colostomy, etc.) has been reported
by Janis (7955).
During mourning there is a combination of factors in which the need
for the lost values, the perception of difference with the compared state,
and even the propriety of mourning concentrate the energies of the
person on the loss aspects. It now becomes clear why the first step in the
adjustment process or in overcoming mourning entails enlarging the scope
of the values to encompass those that are still available to the person. Only
then can the person look to the satisfactions existing in the present and
begin to see that he and his life have something to offer.
Overcoming Mourning
How the scope of values is enlarged is of fundamental importance. We
do know that the values presumed lost may be perceived in a new way,
Value Changes in Acceptance of Disability 1 13
in which their essential aspects are retained and not in fact denied. For
example, the person may come to realize that though he can no longer
run and skip, he can now carry on the essential value of locomotion by
means of his prosthesis, the crutches, or the wheel chair. We also know
that values heretofore undiscovered may become meaningful as the person
struggles with his suffering and reacts to his own feelings and to the
behavior of others. "Faith," for example, may begin to make sense to the
person; or he may begin to appreciate the value of brotherhood and
service to others; or in case of asocial perceptions, he may begin to feel
the value of selfishness, revenge, power. In any case, his horizon becomes
structured with things that matter in one way or another. Although the
lost values may still be important, a necessary condition toward overcom-
ing devaluation has been realized.
But what causes such reevaluation? At first the person is submerged in
a surrounding gloom and then he begins to see that there is meaning to
life, that worthwhile experiences still await him. What produces this shift?
Several processes appear significant.
Dembo and her co-workers (1956) suggest that the essential value, life,
may be regained at the moment the person decides to give it up. Here we
again have the important role played by the perception of what constitutes
change or the difference between two states. In a contemplation of suicide,
the characteristic that differentiates the two states, before and after, is
life. Life, for the moment at least, may then occupy the person's energies
instead of the pervasive suffering. This may provide the first hold, the
feeling of strength and hope called the "stamina experience" and lead to
new awareness of the positive in life.
The factor of perceptual difference with a compared state is also in
evidence when a person, in seeing others who are worse off, first realizes
his assets. G. Barr, himself an amputee and the head of a pharmaceutical
goods company many of whose employees have handicaps, has observed:
"It is valuable psychologically to have different types of disabled workers
together in the same company. . , . The blind man considers himself
much better off than his deaf-mute co-worker. The deaf-mute would not
trade places with the infantile paralysis victim who cannot v/alk. The
infantile paralysis victim feels sorry for the one-armed person. Each one,
when he sees someone else and realizes the limitations forced upon
the other fellow by handicaps he himself does not have, feels he is not so
badly off" (Rusk and Taylor, 1946:1SS).^ This contrast phenomenon is
of therapeutic value when, through it, the person becomes aware of his
own assets or abilities, and particularly that these enable him to partici-
* H. A. Rusk and E. J. Taylor, New Hope for the Handicapped. Harper &
Brothers, 1946. By permission.
1 14 Physical Disability — A Psychological Approach
pate in his own way, as others can in their own way, in the multivaried
world.
Even when the person may believe that nothing matters now, many
values remain at the unconscious level and may be aroused. Dembo et ah
(1956) give an example in which the depression of an amputee was eased
when a close friend ridiculed and scolded his self-pity. This resulted in
awakened pride as a remaining value.
In less depressed states, the sheer necessities of living may contribute
to the turning away from the past and dealing with the here and now. The
paraplegic, for example, has to attend to bodily needs. His needs prod him
to try to move, to turn over, to sit up; and in coping with these problems
he may find a challenge that assuages his rued loss and leads him to
devote his attention to the problems at hand. We can see, now, the
important place, in the process of enlarging the scope of values, of master-
ing "activities of daily living" that modern rehabilitation introduces early
to the patient. The problem still remains, however, of how soon and how
much of the patient's physical and psychic energies should be deflected to
problems of the external world.
It is also likely that a satiation factor enters, helping the person to
overcome his absorption with his loss. One can maintain an emotional
state only so long. One can, for example, be ecstatically happy, but the
peak wanes with time even when the circumstances remain the same.
Similarly, a person may be deeply depressed over a loss, but in time there
is an ebbing of depression. Sometimes, as was previously noted, this is
accompanied by a numbness. The person feels wrung dry and feels no
more. It is as though he were satiated with emotion and even satiated with
preoccupation with the loss. One has mourned and mourned and mourned.
One becomes tired of mourning. Suddenly the person is ready for some-
thing new, something diflferent. The dominance of loss now is abated and,
in his search for diversion, he rediscovers the wider reality. Satiation may
be one important factor permitting a person "to snap out" of a feeling of
hopelessness and grief by himself.
Though it is necessary to leave the state of mourning behind as one
adjusts to the facts of disability, it would be a mistake to conclude that
this should be done with dispatch. There is good reason to believe that
the period of mourning can be a healing period during which the wound
is first anesthetized and then gradually closed, leaving the least scarring.
Lack of recognition of the psychological value of mourning is the basis
for an indictment against one of the military rehabilitation centers for
the blind where, "because of an enthusiastic and efficient attempt . . .
made there to help the blinded soldier master problems of external
reality," it was believed that the inner work of mourning could not be
Value Changes in Acceptance of Disability I 15
accomplished (Blank, 7957.12). This, then, is an issue clearly affecting
the nature of rehabilitation in centers treating the newly injured.
The issue is by no means closed, for there hardly is enough study to
permit conclusive statements. The views presented are rather of the
order of hypotheses requiring continued research for their clarification.
It is significant that certain societies seem better able to prepare their
members for bereavement (Volkart and Michael, 1957). One example of
variable cultural mores affecting the psychic ease of meeting bereavement
is the matter of "replacing" the one lost. Some societies have instituted
obligatory remarriage or adoption, this serving to reestablish the role
vacated by death. Our society, on the other hand, tends to emphasize the
loss aspects of dealth. One even should not speak ill of the dead. However,
the period of mourning during which homage is paid to the dead and
healing takes place is halted at a year, a formality that encourages the
person to resume fully the affairs of the living. Whether "the year" is
generally and optimally satisfactory and whether it has equal relevance
with respect to mourning a physical loss touches upon important social-
psychological issues. Surely this is an area in which research is needed.
Mourning, clearly, is not a state through which one passes and then
leaves behind. It is experienced intermittently after the deepest pangs are
mitigated. Moreover, "one should not draw any strong inference about
psychiatric diagnosis and ego strength from the severity of the symptoms
in the shock stage" (Blank, 1957:12). As the outlook of the person is
further altered by the value changes to be discussed in the following
pages, mourning becomes less persistent until finally the person is able to
look upon his loss with unconcern or a feeling of tenderness rather than
hurt, "with that tenderness which old people not infrequently feel toward
the reminiscences of their youth," now gone, but still a part of them
(Dembo, Leviton, Wright, 1956:39). During the later phases of adjust-
ment to disability, after the person has found a first hold and can carry on
in meaningful activity, further enlargement of the scope of values is
necessary before he can reach what may be called self-fulfillment.
The following dynamic processes important in overcoming mourning
have been considered: comparison of one's state with other worse states,
arousal of dormant values, satiation, involvement in necessities of living.
There are others, but these are sufficient perhaps to demonstrate the
important practical and theoretical problems involved in overcoming
mourning.
SUBORDINATING PHYSIQUE
Even when the person does not doubt that life is worth-while he may
be unduly troubled because of the supreme value that he places on physi-
116 Physical Disability — A Psychological Approach
cal competence or normality. He may, for example, recognize that life
means comfort, friendship, work, and so on but still feel degraded
because he falls below the standards of physical normality. The person,
then, is less troubled when physique becomes a relatively minor value.
Dembo et al. {1956) describe two examples of value change in which
physique becomes less important. In the first of these, physical appearance
matters less and in the second, physical ability matters less. In both
instances, other values matter more and become the important deter-
minants in the evaluation of the person:
1 . The problem of appearance. It is proposed that devaluation resulting
from damaged appearance will be diminished to the extent that surface
appearance is felt to be less important for the evaluation of the person
than personality. This shift is facilitated when the person is convinced of
the fundamental importance of nonphysique values, such as kindness,
wisdom, effort, cooperativeness. Earl Schenck Miers (1949), a man with
cerebral palsy, has expressed this relative subordination of physique values
to personality or character values: "The intolerance of ignorance, the
ruthlessness of avarice, the insanities of lust for power and domination,
the unfeeling heart that must nurture the shameless, all-consuming pride
— such handicaps as these are most to be regretted and most to be
avoided, for from them come much of the world's eternal suffering."
Actually, the perception of the physical appearance may itself change
when it is seen in the light of such personality variables. Thus, whatever
the objective conditions of the surface appearance may be, when one
reacts positively to the person, the appearance may be felt to be attractive,
and vice versa.
In certain circumstances, as among strangers, the influence of per-
sonality recedes to the background and that of surface appearance
becomes a focus of attention. On the other hand, many people naturally
judge a person's attractiveness in terms of personality. This is especially
true among persons in close relationships, where the personality of the
other is felt. It is also true that some people show little concern with
physical appearance because other aspects of life, being much more
highly valued, command a good deal more of the available time and
energy. We are not advocating, of course, neglect of personal grooming,
but we are asserting that placing personality above physical appearance
will reduce devaluation of persons with visible disabilities.
2. The problem of ability and achievement. Dembo et al. introduce the
problem as follows:
To call someone disabled implies that performance determines the evalua-
Value Changes In Acceptance of Disability I 17
tion of the person. In our society, people are frequently compared with each
other on the basis of their achievements. Schools, for example, are predomi-
nantly influenced by the achievement or product ideology. High grades are not
given to the one who worked hardest but to the one who performed best. Under
certain circumstances, of two persons who reached the same performance level,
the one who did so with greater ease is considered the better. He is seen as
potentially a better producer than the one who had to work harder. Thus,
effort is not only considered a positive value, but paradoxically, sometimes as a
liability.
If one would follow the maxim which also exists in our society to the effect
that, "All that is expected of you is that you do your best," it would mean that
the person would not be compared with others in regard to ability; it would
mean that only his own state matters and thus that it does not matter whether
he lost or lacks ability. Actually, one wishes to say, a person does not lack
ability; he can only have it. In everyday life we do evaluate as equally good
citizens those who pay taxes according to their financial state. The injured who
applies himself with effort contributes the most that he can as a person. Though
the unsatisfactory physical tools of his body may have limited his production
[along specific lines] his personal contributions are at the maximum. As a
person he is not different from the noninjured [Dembo, Leviton, Wright,
1956:401
In the preceding discussion physical appearance and ability were botli,
subordinated to personality factors within the person over which he ha«
more control. One may wonder what happens to the person who cannot
claim merit via effort, moral fortitude, or other personality traits. That he
still remains a devalued person is clear, for comparison with a standard
still exists, albeit the standard now pertains to character and personality.
If instead of physical shortcomings we had been discussing acceptance by
a person of his personality shortcomings, such as indolence or selfishness,
we might first raise the moral question of whether one should strive to
accept these attributes; if affirmative conclusions were drawn, subordinat-
ing these traits as values would be indicated. In considering physical dis-
ability, however, devaluation of the person will be diminished insofar as
physical achievement and physical appearance become unimportant as
compared to effort and other personality traits. In the words of Shake-
speare:
In nature there's no blemish but the mind;
None can be called deformed but the unkind:
Virtue is beauty, but the beauteous evil
Are empty trunks, o'erflourished by the devil.
(Twelfth Night, Act III, Scene 4)
I 18 Physical Disability — A Psychological Approach
CONTAINING DISABILITY EFFECTS
Spread
If a person who was below standard in one characteristic felt inferior
only in that regard and not in general, his feelings of inadequacy would
not be destructive of the personality. They may, in fact, be salutary, for
recognizing one's real limitations is an admirable prophylactic against
futile effort, costly of time and morale.
Unfortunately, so sane an appraisal of personal liabilities is not the rule.
Physique (as well as certain other personal characteristics) has an enor-
mous power to evoke a wide variety of impressions and feelings about the
person. In fact, physical deviation is frequently seen as the central key to
a person's behavior and personality and largely responsible for the im-
portant ramifications in the person's life. This spread holds for both the
person with the disability himself and those evaluating him.
To begin with, the physical disability is perceived as spreading to other
physical aspects of the person. Thus, because a blind person cannot see,
it is sometimes taken for granted that he cannot hear, though of course
there is no necessary connection. A mother of a deaf child stated that she
would rather have her child deaf than blind, because "a blind child has
blindness to face as well as deafness."
Overprotection on the part of those close to the person with a physical
limitation may in some measure be a consequence of spread. The parent
of a blind child may keep him confined to crib or carriage because she
feels that without sight the environment is a source of endless danger.
Because the child cannot see, ipso facto he cannot get around at all.
The spread not only affects additional physical areas but also involves
social abilities and events as well. We have seen how Frances regarded
perfect hearing as the open sesame to all the worth-while things in life,
from marriage to career, and impaired hearing as the impenetrable barrier
(see pp. 21-24). Others may look upon the person as less worthy, less
acceptable, and the person himself may concur. Thus, physique affects the
perception not only of abilities but also of acceptabilities.
So it is that the evaluation of the total person is affected by a single
characteristic. Physique has unusual potency in this regard, partly because
it is so intimately connected with the identity of persons, the "self" (see
Chap. 6). In the development of the self-concept, one's physical attributes
become intricately a part of the "I," the "me." However, the fact must
not be overlooked that even what may objectively be entirely independent
of the person may also become connected with the person in such a way
as to affect evaluation of him. A case in point is such a situational factor
Value Changes In Acceptance of Disability I 19
as unemployment, often seen as due to personal qualities (Ichheiser,
1949).
Disability effects are not always easy to contain. It is not simply a
matter of learning that the person is actually restricted only in this way
and that. How often do mothers talk in front of their children about
matters not for their ears, though the mothers know better! Because the
child is small, unlearned, and unaccomplished, the mother acts as though
he does not understand. Even if the mother should be cautioned about
this, she easily slips into the old pattern. The following is an example of
the persistence of spread in the face of ongoing objective evidence that
the person is not restricted in the assumed ways. Karsten Ohnstad, a blind
man, is in the library with a companion. One librarian always talked to
the companion as if Karsten weren't there at all! Karsten recounts:
"What book does he want?" she would ask, looking straight at Oscar who
was standing beside me.
Oscar would turn to me. "What book did you say you wanted?"
"Les Miserables by Hugo."
Oscar would turn back to the librarian. "He wants Les Miserables by Hugo.'*
The librarian got the book. "Does he want to take it with him?"
"Do you want to take it with you?"
"Yes, I want to take it with me."
Oscar would turn wearily back to the librarian. "Yes, he wants to take it
with him."
The librarian put the book on the table. "Does he want it signed in his own
name?"
"Do you want it signed in your name?" Patient Oscar.
"Does he . . ." began the librarian.
"No, he doesn't," I said. "He's changed his mind. He doesn't want a book."
I hurried out of the building.
"Now whatever do you suppose got into him?" I heard the librarian asking
Oscar [Ohnstad, 1942:61-61>l^
Pertinent Research Findings
In one experiment, mentioned earlier in another connection (p. 57),
(Mussen and Barker, 1944), college students were asked to rate cripples
in general on 24 character and personality traits, such as conscientious-
ness, self-confidence, etc. The task was seen as a sensible one by the
subjects, and this reaction alone has important implications. If one pauses
to consider that nothing more was said about the group to be rated than
that they were cripples, it is amazing that the task could be executed at
5 Karsten Ohnstad, The World at My Fingertips, Indianapolis, The Bobbs-
Merrill Company, 1942. By permission.
120 Physical Disability — A Psychological Approach
all. Yet it was possible for these subjects to make judgments about a wide
range of personality traits, simply knowing one characteristic about the
group, and a physical rather than a personality characteristic at that.
In a second experiment, also referred to previously (p. 51), half of a
group of high school subjects were shown a photograph of a college boy
sitting in a wheel chair, and the other half were shown the same picture
with the wheel chair blocked out (Ray, 1946). The college boy in the
wheel chair was judged to be more conscientious, to feel more inferior,
to get better grades, to be more unhappy, than when depicted as non-
crippled. Again the single fact of physical deviation was able to affect the
perception of the kind of person being judged.
A similar phenomenon occurs in regard to other characteristics of
groups — nationality, for example. Katz and Braly {1933) studied the
racial stereotypes of college students by having subjects select from a list
of traits those most typical of ten ethnic groups. One of the important
findings that has not been stressed because it is so easily taken for granted
is that the subjects felt able to rate groups with which they had had no
contact (for example, Turks).
The interesting question is, How can subjects generalize from a single
characteristic, such as crippling, so that a vast array of expectations as to
personality and behavior are evoked? Fruitful empirical data on this
question could be obtained directly by asking the subjects themselves to
elaborate and explain their judgments. What, for example, would a par-
ticular subject say who rated cripples as having a marked tendency to be
unselfish? One subject might say, "They have suffered so much that they
have become more sensitive to people's wants." Another might say, "This
is one way they try to be accepted by others."
Such responses suggest that the subject's impressions need not neces-
sarily be arbitrary ones but may have their origins in the way he views
disability. He is able to generalize from the physical characteristic because
this represents for him a crucial deviation that affects a person in ways he
presumes to understand. That is to say, the subject's judgments are partly
based on hypotheses as to crippling as a value loss. He sees, for example,
that crippling leads to suffering, which is a necessary prerequisite for
sensitivity to others' needs. If he regards crippling as a state to which one
can adjust, his judgments could be expected to differ markedly from the
case where he regards crippling as an overwhelming calamity.
Even subjects who rate cripples sometimes favorably and sometimes
unfavorably are likely to hold not arbitrary and discrete impressions of
cripples but impressions that are coherent in terms of underlying attitudes
toward crippling. One can see that if a person describes those with ortho-
pedic handicaps as trying harder than most and also as being more sensi-
tive than the average, he is not necessarily being inconsistent. Manv of
Value Changes in Acceptance of Disability 12!
our impressions of one another or of groups have a meaningful character
(.Asch, 1952). To explore by further questioning, the attitudes of subjects
who have atypical physiques and those who do not is a promising pro-
cedure for arriving at some of the rational roots sustaining attitudes
At the same time, we do not wish to deny the existence of what may
be called rather arbitrary impressions of a person. There is reason to
believe that a type of spread occurs from one characteristic of a person
to others with little in common other than the fact that they are also
positive or also negative. Such spread properly belongs with the phe-
nomenon known as the "halo effect," a term introduced by Thorndike
{1920), and is related to Heider's {1958) unit-forming factors (see p.
262), as well as to Dembo's {1953b) "comparative values" (see p. 128).
In this instance, the hypotheses of the evaluator probably are after-
thoughts, the evaluations being formed independently of them.
In his series of well-known experiments, Asch {1946) has contributed
considerable understanding to the problem of how we form impressions of
personality. He distinguishes between qualities that furnish the key to a
person and those that are subsidiary — i.e., between central and peripheral
characteristics. In one experiment, two groups of subjects were read a list
of personality traits, identical with the exception that one group heard
the person described as "warm" and the other group as "cold," thus:
1. Intelligent — skillful — industrious — warm — determined — practi-
cal — cautious
2. Intelligent — skillful — industrious — cold — determined — practical
— cautious
If the character traits "warm" and "cold" are central aspects of a
person, they should affect the total impression of personality. That this is
the case is shown in the accompanying tabulation, which reports the
results obtained when the subjects were asked to select from a check list
of pairs of traits, mostly opposites, the quality that best fitted the impres-
sion they had already formed. The positive terms of each pair appear in
the tabulation.
Warm
Cold
N = 90
N = 76
Generous
91
8
Wise
65
25
Happy
90
34
Good-natured
94
17
Humorous
77
13
Sociable
91
38
122 Physical Disability — A Psychological Approach
Warm Cold
N = 90 N = 76
Popular
84
28
Reliable
94
99
Important
88
99
Humane
86
31
Good-looking
11
69
Persistent
100
97
Serious
100
99
Restrained
11
89
Altruistic
69
18
Imaginative
51
19
Strong
98
95
Honest
98
94
The "warm" person was described as being generous, wise, happy, good-
natured, humorous, sociable, popular, humane, altruistic, and imaginative
much more frequently than the "cold" person. There was also a set of
qualities that was nof affected by the warm-cold variable, e.g., physical
attractiveness, reliability, strength, seriousness, etc. Thus, though the
central characteristic affects the impression of the total personality, it does
not function as an undiscriminating "halo effect." Duplicating this experi-
ment utilizing "crippled-physically normal" as the variable would demon-
strate that physique is a central characteristic of a person that gives rise
to notions as to the kind of person he is through the subjects' hypotheses
concerning the social-psychological significance of physique.
In a second experiment Asch (7952) showed that the order in which
the characteristics of another are experienced may make a real difference
in how he is viewed (p. 211). Two series of identical personality traits
differing only in their order of presentation were read to separate groups:
Series A : Intelligent — industrious — impulsive — critical — stubborn —
envious
Series B\ Envious — stubborn — critical — impulsive — industrious —
intelligent
The order of traits is merely reversed. Series A opening with positive
qualities. Series B with questionable qualities. In general the subjects'
impression of A is that of an "able person who possesses certain short-
comings, which are not serious enough to overshadow his merits" whereas
B impresses the majority as "a 'problem' whose abilities are hampered by
his serious difficulties." Apparently, first impressions of a person are
especially potent in that they set up a direction that exerts a continuous
Value Changes in Acceptance of Disability 123
effect on later impressions of that person, "The view formed quickly
acquires a certain stability; later characteristics are fitted to the prevailing
direction when the conditions permit" (Asch, 1952:212-213).
Determining the precise conditions that give to physical characteristics
their central organizing position requires continued research. On the basis
of the evidence above, it might be postulated that visible handicaps are
especially potent insofar as they present the person to others first in terms
of his physique and thereby condition subsequent impressions.
Ichheiser (1949), in a penetrating consideration of the image of the
other man, stresses visibility as a main determinant of social reality. He
points out that coercion is more objectionable when it is evident in out-
right violence than when it is invisible. Likewise, bodily appearance
assumes a major role because the visible appearance of an individual, and
not his invisible personality, constitutes the main basis of identification.
Ichheiser offers the following dramatic sketch as an example:
Suppose Jane Doe would change all her inner personality characteristics,
such as her attitudes, opinions, tendencies, character, temperament, and
whatever else. At the same time, suppose she would retain unchanged her
bodily appearance. Then, obviously, she would continue to be considered and
identified as "the same person." Other people would probably say that Jane
Doe has radically changed, but it would be still Jane who has changed. If, on
the other hand, Jane would maintain all her inner personality characteristics
but would by some miracle altogether change her bodily appearance so that
she would look like Susan Smith, then she would cease, in terms of social
reality, to be "the same person." People would then, obviously, consider and
identify Jane as being Susan, and they would probably wonder why Susan talks
and behaves like Jane [1949:17].
In a study of the social usefulness of the cosmetic glove for arm ampu-
tees, Cattell, Dembo, et al. (1949) have contributed valuable material on
some of the conditions determining centrality of physique. The conclu-
sions are based on data derived from several lifelike experimental settings.
In one setting the experimenter, an observer who took notes, and an
amputee with a cosmetic hand prosthesis went to a store as ordinary
customers. The salesman did not know that he was the subject of a
psychological experiment. The amputee engaged the salesman in con-
versation and tried to draw his attention to the cosmetic hand by putting
it on the counter, by gesturing, scratching his face, smoking, etc. The
contact lasted between 5 and 20 minutes, after which the amputee left^
and the experimenter and observer approached the salesman for an inter-
view designed to elicit his reactions to the cosmetic hand.
The cosmetic glove is designed to approximate as closely as possible the
appearance of the natural hand. Though on closer inspection the cosmetic
124 Physical Disability — A Psychological Approach
hand is noticeably different from the natural hand, in casual contacts 80
percent of the subjects, not recognizing the cosmetic hand as such, were
completely unaware of any difference. The investigators account for this
by distinguishing between the region of visual presence and the region of
visual concern. The region of presence encompasses those objects that are
perceived but not inspected, the region of concern those which command
the focus of attention. The cosmetic hand, when in the region of presence,
matches the normal hand sufficiently not to be noticeable, whereas when
it becomes a part of the region of concern, obvious differences emerge.
In casual contacts we do not usually concern ourselves with the hands of
the other person. Thus, "during a first meeting with someone, which may
be the initial stage of a lasting relationship, the cosmetic hand is seen as
useful, because it allows the non-wearer to get to know the wearer as a
person before the fact of a prosthesis and feelings about the injury and
amputation come into play" (Cattell et al., 1949:28).
Undoubtedly, too, variables within the beholder will influence the
prominence of physical characteristics in another. The principle of
vigilance (see pp. 41-42) is relevant. If the person is anxious about
health and physique, or if he is alerted to bodily facts for other reasons,
such features will become outstanding qualities.
Apparently, the observer need not be aware of the physical charac-
teristics of another for them to influence his impressions. Winkler {1931)
presented action pictures of healthy and crippled children to 200 physi-
cally normal subjects who were to judge them according to personality
traits. Some of the crippled children were not consciously recognized by
the subjects as being crippled. Unfavorable judgments regarding the non-
disabled children constituted 46 percent of all judgments about them,
whereas of the judgments made about the children who were not recog-
nized as crippled 60 percent were unfavorable. Possibly the postures of
crippled children, although not sufficiently peculiar to be consciously
recognized as crippled, served as a stimulus for an unconscious negative
reaction. Other evidence supports the validity of these findings (Barker
et al., 1953:11).
The next chapter discusses two other psychological factors, "the self-
connection gradient" and the "status-value gradient," which are believed
to be significant determiners of spread from a single attribute to the total
person.
Theoretical and Social Missteps
That the effects of physical disability are seen as spreading beyond t-«c
narrower physical confines into diverse areas of the person's life is well
established. Actually, the unconditional central role of physique has led
Value Changes in Acceptance of Disability 125
to one-sided theories about adjustment to handicap and has created dif-
ficulties in interpersonal relations involving persons with disabilities.
Let us consider the marked inclination to "understand" a person's
accomplishments solely in terms of his disability. We have called the
rationale for this the theory of compensation as indemnity (see pp. 49-
51). Because it is felt that a person attempts to make up for an undesira-
ble trait by emphasizing a desirable trait, all his efforts are seen as devoted
to that end. The following is representative of this kind of thinking: "A
well-known psychologist brought together some very interesting and
enlightening factual information concerning some famous personalities
who achieved greatness and distinction through relentless effort to com-
pensate for organic inferiority and physical limitation" (Wilson, 1950:
192). The author then goes on to mention several accomplished sportsmen
who achieved, it is supposed, because of their physical deficiencies — e.g.,
Armette Kellerman, who "compensated for her frail body by rigorous
swimming and became one of the great women swimmers of all time" (p.
192). To us, it is still a moot question whether Annette Kellerman's
performance should be seen primarily as compensatory, but the issue is
even more clearly drawn in the following remarks, made specifically to
illustrate the principle of compensation:
The record in the field of intellectual accomplishment is even more amazing.
Robert Louis Stevenson was racked with tuberculosis and kept moving from
one health resort to another. Charles Darwin was so sickly that he was limited
in his work to only a few hours each day. Lord Byron's whole life was altered
by his club foot. Edgar Allan Poe was the victim of a lung condition. The
philosopher Kant carried on his writings in a state of continual pain caused by
gout and his sunken chest. The philosopher Nietzsche, conscious of his frail
body, conceived a philosophy of the superman. Aristotle and Demosthenes were
physical defectives. The poet Goethe always complained that his life was all
pain and burden, and once stated that in his whole life of seventy-five years he
had not even four weeks of general well-being. Beethoven was pockmarked and
snubnosed. He was continually harassed by asthma and digestive disorders, and
at the age of twenty-eight, became deaf . . . [Wilson, 1950:193].
This passage clearly exemplifies how the undisciplined spread of the
effects of disability can distort the meaning of crucial aspects of a person's
life. The disability is seen not only as entering everjrwhere but as being
the critical element in the events of life. Surely, the fact that "Charles
Darwin was so sickly that he was limited in his work to only a few hours
each day" is not sufficient to account for his absorbing interest in evolu-
tionary processes. A review of his intellectual and emotional life most
certainly would reveal that physique played a role, but as certainly not
126 Physical Disability — A Psychological Approach
the role, not the one factor primarily responsible for the directions
assumed by his life.
When it is assumed that disability effects spread in unbridled fashion,
it is hardly conceivable that a person might pursue an area of work simply
because he finds it satisfying. Every effort, every interest is presumed to be
a compensation for the person's physical deficiency. The theory of com-
pensation as indemnity gives to physique a central organizing role to
which life motivations are dynamically linked. The view emphasizing
containment of disability, on the other hand, includes physique as but one
among an array of factors that determine the direction and intensity of
the person's efforts.
The intrusive power of atypical physique to dominate our perception
of the person can also be seen in the unbalanced emotional evaluation of
the state of disability. When disability is seen to dominate the entire life,
it is interpreted as a tragedy from which there is no respite. Thus it is
that a person may feel, "I would rather be dead than stone deaf or blind
or . . ." On the other hand, the recognition that deafness or blindness
permits a life of competence and enjoyment requires putting the physical
characteristics into a subordinate place of sharing with other factors,
consequences, and effects.
The unrestrained spread of physique is again seen in the attitude that
persons who have a disability stand apart from, rather than are a part of,
the community of others. It is said, for example, that "a handicapped
child can nevei have the satisfaction of being just like other children."
Does this mean that his physical difference is always so central that it
looms as the major feature of every situation? Clearly not. A more ac-
curate statement of group identification might read: "A handicapped
child can feel just like other children, even though at times he may feel
different in certain particulars. This is true of all children." To see a handi-
capped child first and foremost as a child and only secondarily as a handi-
capped one is a significant adjustive sign in a parent. Too often the child's
diflSculty is attributed to his handicap rather than to the preeminent
circumstance of his relative immaturity or some other pertinent condition.
Such titles of books and pamphlets as Understanding the Disabled help
to foster the invidious tendency to perceive disability as creating psycho-
logically different kinds of people. All too readily is it assumed that
persons with disabilities take a great deal of knowing before they can be
understood or accepted on the usual level.
The role of atypical physique as prime mover also leads to difficulties
in interpersonal relations. Sources of tension that arise in social contact
must be adequately evaluated in order that one's efforts be focused cor-
rectly in alleviating them. Yet when a person who is physically deviant is
involved, the source of difficulty is often laid to the disability, even
Value Changes In Acceptance of Disability 127
though other events and personality characteristics may be more im-
mediately responsible.
Misperception of this sort occurs both in the person himself and in the
nonhandicapped. The person may attribute to his crippling the fact that
he is not invited to someone's house, when actually the host may not
enjoy him as a person irrespective of his physique, or may wish to invite
him on a more suitable occasion. This feeling of being reacted to as a
stereotyped version of a deaf person or a crippled person is one important
factor in the belief of some persons that they can never be understood by
the nondisabled, that forever a chasm exists between them.
The following incident took place when Henry Viscardi, dwarfed
through congenital malformation of the legs, was 7 years old. By this
time he had had several harsh experiences which taught him that except
for those who knew him he was an object of pity, to be ostracized and
ridiculed. He jumped to the conclusion that he could not enter the church
because he was crippled — and it was a wrong conclusion:
But as we stopped by the holy-water font a man at the church door looked
at me sharply and whispered something to papa. The other people stared at us
too.
What is wrong? I wondered. Do you suppose crippled children are not
allowed to come to church any more? [Italics ours.]
Papa took my hand and led me outside. "Let us go for a walk in the park,"
he said, smiling brightly.
My eyes were smarting. "What's the matter, papa?" I finally said. "Why
didn't we stay for Mass? Is it because I'm crippled?" I could hardly get the
words out.
Then Papa threw back his head and laughed. And he laughed again.
"Oh, this is very funny," he said.
I did not think it was funny, and I wished I had never come to church with
him. I had a salty taste in my mouth.
Then he put both his hands on my shoulders and looked right into my eyes.
"Oh, this is very funny — no children allowed at eleven o'clock Mass. What a
way to run a church!" I laughed too, just to be polite [Viscardi, 1952:24-25].^
From the point of view of social reality, the person is sometimes reacted
to in terms of physique alone. There also are times, however, when he is
reacted to primarily in terms of personality characteristics. And sometimes
impersonal circumstances are the main determining factors. But the basis
is often ambiguous, and the emotional nature of attitudes about physique
interferes with clarification. In the following example, Karsten Ohnstad
6 Henry Viscardi, Jr., A Man's Stature. Copyright, 1952, by Henry Viscardi,
Jr. Used by permission of The John Day Company.
128 Physical Disability — A Psychological Approach
was very sure that the girl stopped writing to him because he was blind.
Was he right?
A letter arrived from an unexpected source — from the pretty blonde girl back
home. I listened with a glow of pleasure and embarrassment as I sat on my bed
while my favorite nurse read the letter aloud. I had not expected to hear from
the girl. ... A nurse wrote the reply I dictated. The blonde girl had said in
her letter that she would write again. I waited — one week, a month. I made a
decision. She had written purely out of sympathy. I took her letter and tore it
to bits. This, I decided, was part of my new education [Ohnstad, 1942:29-30].
There simply is not enough evidence for a reliable verdict as to the
circumstances surrounding the girl's silence, and such ambiguity repeats
itself in the life of every person with a disability.
Ambiguity of social position is, of course, true of all minority groups.
The Jew or Negro, for example, has to pit the possible circumstantial or
personality reasons for his lack of acceptance in a particular situation
against what may be equally possible prejudicial reasons. And such
ambiguity is well known to everyone, even to those among the favored
majority. Everyone has occasion sometimes to wonder whether he was
rejected or whether the discomfiting incident was the product of non-
personal factors. And many times the person does not pause to wonder
but simply takes it for granted that the explanatory key turns upon his
disability, his race, his poor manners, or whatever else is an emotional
touchstone. Sometimes he may be right. Not infrequently he is wrong.
All persons, those with a disability and those without, must be educated
to the more cautious yet more veracious understanding that, though a
physical disability is a physical fact whose psychological effects radiate to
other areas of the person's life, the effects can be contained more precisely
within those areas that are dynamically linked or 'caused by" disability
factors. Not all of life is influenced, let alone determined, by disability.
The person with a disability must be encouraged to pinpoint the values
now lost to him so that they become but dots in the large map of the
world, in which vast areas remain relatively intact and accessible. He will
then realize that he is not a disabled person but a person with a disability,
that life has a multitude of meanings, opportunities, and frustrations, only
some of which are disability-connected.
COMPARATIVE VALUES AND ASSET VALUES
The reaction to something, be it a person, thing, event, or performance,
may be favorable, unfavorable, or neutral. But such judgments may be
brought about through at least two distinct psychological processes, involv-
Value Changes in Acceptance of Disability 129
ing vs'hat Dembo has called comparative values and asset values (Dembo,
Leviton, Wright, 1956).
If the evaluation is based on comparison with a standard, the person is
said to be invoking comparative values. The standard may represent the
presumed average, as when a person is judged to be bright or stupid; it
may represent certain "ought" characteristics, as when a person is judged
to be a good father or a poor father; it may represent certain formal
requirements, as when a person is evaluated for membership in a social
club.
On the other hand, if the evaluation arises from the qualities inherent
in the object of judgment itself, the person is said to be invoking asset
values. What matters is the object of judgment in a setting that has its
own intrinsic purposes and demands. The person's reaction is then based
upon how appropriately the situational demands are fulfilled rather than
on comparison with a predetermined standard. Consider the following
illustrations: A person may enjoy the musical performance of his ac-
quaintance without comparing it with the performance of anyone else. He
sees the situation as one in which the performer is playing for pleasure
and the listener is to listen for pleasure. In these circumstances he is able
to enjoy the assets of the performance itself. A second listener, evaluating
on the basis of comparative values, does not enjoy the musical perform-
ance because he constantly compares it with the playing of a great
virtuoso. He cannot appreciate what this musician has to offer, because
the music is felt not to be up to a certain standard. Other terms that may
clarify the conception of asset values are "intrinsic values" and "substan-
tive values."
Some persons appear to be very comparison-minded, always sizing up
others in comparison with themselves, for example, or with some symbol
of status such as wealth or education. It is not by accident that these
persons are called status-minded, for evaluations of status and prestige
require the standards of comparative values. There are other persons who
hold predominantly asset values and employ comparative values only
in special circumstances. When, for example, such a person is called upon
to hire a new member to his staff, he will offer the job to the better of two
candidates according to predetermined standards. In this case, the nature
of the situation demands comparative evaluation. When, however, the
asset-minded person is not subject to a comparative frame of reference,
he may well be satisfied with the rejected applicant. He now is no longer
comparing the person against a standard; he is simply appreciating his
qualities for their own worth, much as he can enjoy a summer day with-
out comparing it with other days. To be sure, the evaluation of the
summer day will be affected by one's experience with other panoramas. If
one has been having consistently beautiful sunsets, one may be rather
130 Physical Disability — A Psychological Approach
blase toward the same beauty the following evening, instead of being
uplifted as one had been on the first occurrence. But the evaluation itself
at the time of evaluation is not a comparative one, and the thing is en-
joyed or disliked because of its inherent qualities in a situational context.
The person with a disability has much to gain psychologically if he can
look upon physique in terms of its inherent or essential characteristics —
that is, what it permits him to do and what it restricts him in doing —
without basing his evaluation on comparison with other individuals or
with his previous nondisabled state. The perception of what physique
permits and restricts depends, of course, upon knowledge of what other
persons can do. A person would not think of his hearing impairment as a
restriction if everyone else were similarly affected, just as we do not mind
not being able to hear high frequencies. Nevertheless, when physique has
the function of an asset value, the person is able to appreciate those
inherent satisfactions that are but disappointments the moment physique
is taken as a comparative value.
This analysis may arouse skepticism. But incredulity shades into under-
standing when one considers that walking in itself is always a remarkable
achievement. Aren't we pleasingly amazed when the toddler takes his first
faltering steps? Why? Surely, if we consider that almost all babies in their
second year of life embark upon such an expedition it is not remarkable
at all. Such emotional nonchalance, however, is forced upon us only when
comparative values form the basis of our evaluation of baby behavior,
but when "norms" of whatever kind are not a part of the picture, we can
thrill at the first tooth, the babbling, the uncertain steps.
Parent-educators, particularly since the 1930's, have been strongly urg-
ing parents to enjoy their children, to accept them as they are without
attempting to mold them into an ill-fitting pattern of the boy or girl they
would like. This principle, translated into value terms, states: Regard the
characteristics or attributes of your children as asset values. Then you
will be able to enjoy your children for themselves rather than for their
relative position in the group or on some other predetermined standard of
behavior.
Let us look in on 5-year-old Raymond crawling for the first time since
polio struck him almost a year and a half earlier. He is sitting on the floor
with his toys surrounding him :
On one momentous occasion I gave the engine a great shove, failed to hold
on to it, and it rolled away beyond my reach. I hesitated to call Celia [the
nurse], for she fussed, but I wanted my engine, and I decided to try to go after
it myself. I placed my hands, palms down, on the floor in front of me. I moved
my legs from the hips, moved them more than I had ever moved them before,
until they were behind me and under me and I was on my knees. I put my
Value Changes in Acceptance of Disability 131
right hand forward and pulled my right leg forward. I put my left hand forward
and pulled my left leg forward. I repeated the actions and soon I was across
the room where my fire engine waited for me.
... I remembered the act and the emotion, the ineffable joy that flooded
me, the sense of power, of achievement, of a miracle wrought. . . . Later I
was to feel the crushing weight of shame, but the memory of what happened
to me that day helped me to bear up and struggle on. I crawled six feet across
the carpeted floor and the course of my life was charted.
When I reached my fire engine, the enormity of what I had achieved flashed
upon me. I twisted my body around and sat down. My eyes filled with tears
of happiness. I had been over there and now I was over here, and I had done
it all myself! (Goldman, 1947:10-11).
Raymond was exalted by the wonder of his accomplishment because at
that moment his evaluation of himself and his behavior was asset-
determined. He was not comparing his achievement with a norm, a
standard of behavior. He was just savoring it for what it was — a sense of
power. "I had been over there and now I was over here, and I had done
it all myself!"
Physique as an asset value provides a sound basis for the commonly
heard dictum, "It is not what you have lost, but what you have left that
counts." It is significant that when Harold Russell, who lost both hands in
World War II, first began to realize the truth of this dictum he also began
to take himself in hand with these admonitions: "I would have to stop
regarding myself as a freak. I would have to stop sneaking into dark
corners and hiding my hooks. ... I would have to realize that I had
nothing to be ashamed of" {1949:142). It is significant because these
admonitions express the dim recognition that physique can become an
asset value, a view that would free him of shame and inferiority. Gradu-
ally shamming and shaming no longer pursued him and he was able to
share with McGonegal, the man who lost his hands in World War I and
whom he grew to admire, the insight that "self-respect and real pride are
better fed by achievement than by concealment" (p. 108).
Dembo (1953b) has developed further the theory of comparative
values by showing that not only is the evaluation of the disability by the
holder of comparative values different from that of the holder of asset
values but that other characteristics of the person, and even the total
person, are also evaluated differently. She points out that when we com-
pare an object with a standard, we are interested in only certain charac-
teristics of the object (e.g., physique). Because these characteristics are
within our field of concern, they become potent and have the power to
impose their properties upon our perception and evaluation of other
characteristics not being compared at the moment and which, therefore,
132 Physical Disability — A Psychological Approach
are vague and unstructured. If physical normalcy is taken as a standard
and a disability is viewed as far below standard, other vague character-
istics and the person himself are regarded as below standard. In a diffuse
sort of way the person comes to be regarded as an inferior being.
For a perceptive view of such devaluative spread, let us again consider
some of the recollections of Harold Russell (1949). His first reaction
upon awakening in the hospital was one of aversion (see p. 61). During
that first week he shuddered with horror at the thought of "hooks" for
hands. He was revolted by a civilian visitor without hands: "He was fat
and chubby and he kept scratching his bald dome with the claws. It gave
me the creeps" (p. 41). The prospect of going through life with "steel
claws" terrified him, for it would mean that he would be openly advertis-
ing the fact that he was a cripple and a freak. During this early struggle,
Russell felt so totally worthless that he vowed he would not marry his
girl, because "How could I let her throw herself away on me, a helpless
cripple?" (p. 44). He longed to be wrong in his picture of himself and
instead to believe that he was a man in spite of all that. In his fantasy
he sought proof of real love from his girl :
My reason told me I should and must give her up, but all my instincts told
me I should cling to her, that she could be my ultimate salvation. If only I could
be sure she loved me — really loved me — not out of pity, not out of loyalty, not
out of a sense of duty! To know that I was still desired, to know that a woman
could still love me as a man, that was the all-important thing. That knowledge,
I felt, could lift me over the highest hurdles. It could give me new hope and
courage. It could make me into a human being again, instead of a helpless
freak.
But I knew that could never be. I knew that no matter what she said — no
matter how fervently she proclaimed her love — no matter how many times she
told me she still wanted to marry me — I knew that I would have to give her
up. There was no other way [Russell, 1949:45].
What has happened here? Because Russell felt so abnormal with
respect to a major physical characteristic, because at this time his dis-
ability was the thing of importance, occupying his entire thinking, the
horror and aversion spread to himself as a total person, and he became a
useless freak, a travesty on the human being he had been.
The following reminiscence of Noreen about her prepolio days helps
to enlighten the phenomenon of comparative values and diffuse spread:
... I am simply inconsolable at horse-races or relays of any kind, for
worrying about the unhappiness of the contestant who comes in last. At gala
night-club scenes in the movies, I always search out the background for extras
Value Changes in Acceptance of Disability 133
who sit at the gay tables with unconscious envy painted on their pretty faces as
they watch the star perform. At weddings I watch the least of the bridesmaids,
and at graduation exercises, the little girl whose dress has the widest hand-made
hem [Linduska, 1947:15].''
Why does Noreen's heart go out to the person who is last, an extra, a
lesser bridesmaid, or a girl with the widest handmade hem? These may
be facts, but they have no necessary connection with being unfortunate.
The wide hem may belong to the girl who is brimming over with the
anticipation of marrying her beloved after graduation. The contestant who
comes in last may be pleased to have been part of the race at all. Not
everything that can be rank-ordered involves a contest. But for Noreen,
relative position on this characteristic or that meant so much that it
spread to the evaluation of the total person. Being below par on one
characteristic spelled being the underdog.
It has been noted that "even social workers accustomed to dealing with
all types often find it difficult to think of a normal, pretty girl as being
guilty of a crime. Most people, for some inexplicable reason, think of
crime in terms of abnormality in appearance, and I must say that beautiful
women are not often convicted" (Monahan, 1941:103). At this time we
are able to suggest two hypotheses for this "inexplicable reason." In
Chapter 10 the question of "requiredness" in attitudes toward disability is
discussed. There it is pointed out that one a priori connection relates dis-
ability to wrongdoing, both being negative in character (see p. 258). A
second explanation, drawing upon the properties of comparative and asset
values, argues that the social worker finds difficulty in thinking of a pretty
girl as guilty of a crime when he holds beauty as a comparative value.
Then, when the girl's beauty is in the field of concern, its property of
being above standard spreads to other characteristics of the person so that
the social worker would also see a moral girl. The spread effects are
incompatible with a below-standard characteristic such as criminality.
It is certainly possible that both factors, that of a priori requiredness
and that of diffuse spread, play a role. Yet it is possible to disentangle
them if one would select an "asset-minded" rather than a "comparison-
minded" social worker and discover if the difficulty described above
existed to the same degree. If it did not, it would be legitimate to give
considerable weight in the phenomenon to the asset-comparison nature
of values, whereas if it did, a priori requiredness would be the telling
condition.
" Noreen Linduska, My Polio Past, copyright 1 947 by Noreen Linduska.
Used by permission of the publishers, Farrar, Straus and Cudahy, Inc.
134 Physical Disability — A Psychological Approach
ACCEPTANCE AND ADJUSTMENT
The preceding sections have outlined the kinds of change within the
person's value system that are significant in his acceptance of a dis-
ability. The resulting acceptance frees the person of devaluation because
of a disability and also frees him to seek satisfactions in activities that
befit his own characteristics as a person rather than those of an idolized
normal standard. The assumptions made and the consequences presumed
lead us to expect that a person who in these terms accepts his handicap
would be well on his way toward becoming well adjusted. The final
verdict, however, must await scientific exploration.
To begin with, it must be borne in mind that there is quite a jump
between accepting one's disability in particular and accepting oneself in
general. The self-accepting person has been defined (Berger, E., 1952, as
modified from Sheerer, 1949) as one who:
1. Relies primarily upon internalized values and standards rather than on
external pressure as a guide for his behavior.
2. Has faith in his capacity to cope with life.
3. Assumes responsibility for and accepts the consequences of his own be-
havior.
4. Accepts praise or criticism from others objectively.
5. Does not attempt to deny or distort any feelings, motives, limitations, abili-
ties, or favorable qualities which he sees in himself, but rather accepts all
without self-condemnation.
6. Considers himself a person of worth on an equal plane with other persons.
7. Does not expect others to reject him. . . .
8. Does not regard himself as totally different from others, "queer," or
generally abnormal in his reactions.
9. Is not shy or self-conscious.
It is not difficult to reason that a person who enlarges his scope of
values, confines disability effects, subordinates physique as a value and,
particularly, regards physique as an asset value also will show beneficial
effects with respect to most if not all of the nine self-accepting criteria.
Value changes do not occur in isolation. A major change in outlook with
respect to part of the self reflects or affects the self-concept in general (see
Chap. 6). Yet, experiment and systematic observation must remain as the
supreme court, where fact may be sifted from fancy.
Likewise, it must be borne in mind that there is also a jump between
accepting oneself and being a mentally healthy person. The emotionally
mature person has been characterized as follows (Saul, 7947.- Chap. I) :
Value Changes In Acceptance of Disability 135
1. He is independent and responsible.
2. He has little need to regress.
3. He is giving and productive, although still able to receive normally.
4. He is cooperative rather than egotistical and competitive.
5. He is in relative harmony with his conscience.
6. He is reasonably free of inferiority feelings and his anxiety is at a mini-
mum.
7. His attitudes toward sexuality show a balance between freedom and
responsibility.
8. His hostility toward others and toward himself is minimal but is freely
available for defense and constructive use.
9. His grasp of reality is clear and unimpaired by the emotional astigmatisms
of childhood.
10. He is discriminating and highly adaptable.
11. He not only has the capacity for such attitudes and functioning but also
the ability to enjoy them fully.
Again, it is not difficult to reason that there is a necessary connection
between these characteristics and self -acceptance. Although adjustment
involves a broader spectrum of characteristics than self-acceptance, they
appear on conceptual grounds to be mutually consistent. But, again,
actual data must be the prime witness.
Unfortunately, what appears to be the most relevant study lacks ade-
quate data for final evaluation of the issue of acceptance and adjustment.
Landis and BoUes {1942) interviewed 100 handicapped women 17 to 30
years of age. On the basis of the interview data, the subjects were rated
on General Adjustment, Adequacy of Adjustment to Handicap, and
Method of Adjustment to Handicap. With respect to the latter, four styles
of reaction were distinguished: withdrawal, substitution, obliteration,
compensation.
Of these four, obliteration comes closest to what we have described in
Chapter 2 as denying and concealing, but none of them applies to the kind
of basic value changes we have included in our conception of acceptance.
Substitution might, but there are no indications that the substitutions were
brought about by containing disability effects or subordinating physique as
a value or changing physique to an asset value. As a matter of fact, about
half the subjects who used this method reported that the substituted
activities were merely unsatisfactory escapes or "time killers."
The authors evaluate these four types of adjustment with respect to
both personal satisfaction and social acceptability. On both coimts,
obliteration is placed first, substitution second, with the remaining two
lagging behind. Unfortunately, aside from general statements relating
method of adjustment to general adjustment, very little is given in the way
of actual data. All we know is that of the 17 subjects whose method of
136 Physical Disability— A Psychological Approach
adjustment to the handicap was rated as withdrawal, only 5 were rated
as showing adequate general adjustment, whereas of the 16 subjects
given the obliteration rating, 15 were rated as showing adequate adjust-
ment. Comparable figures on the other methods of adjustment are not
given, nor are data relating method of adjustment to adequacy of adjust-
ment to handicap.
Seemingly the relatively high rating of the obliterative style of reaction
runs counter to the argument presented in Chapter 2, which undertakes
to show the futility of "as if" behavior. However, there are difficulties in
interpreting the high rating in the light of the following facts: (1) The
Rorschach records of the ten subjects who were rated as most maladjusted
showed no significant difference in the number of neurotic signs as com-
pared with the Rorschach records of the ten subjects who were rated
highest in adjustment. (2) Except for the withdrawal type, the Rorschach
test gave no evidence of consistent tendencies in the personality make-up
related to any of the other three types of adjustment to handicap. Add to
this the possibility if not probability that the girls who denied any hmita-
tions whatever would also tend in an interview to deny any troubles
whatever, thus accounting for the spuriously high adjustment ratings, and
we have reasonable grounds for feeling that the present evidence is inade-
quate and future research on this issue is imperative.
Acceptance of a disability has been discussed in terms of four kinds of
change within the value system of the person. Clearly there may be others,
and certainly these are interrelated. Thus, enlarging the scope of values
appears to be favorable to subordinating physique, for in the perspective
of other values physique may become one of lesser rank. Subordinating
physique is also apt to lead to some containment of disability effects; for
if physique becomes less significant, its effects become less involved. The
converse is also true: containing physique at the same time tends to deflate
it. The inauguration of these three value changes facilitates the ultimate
transformation of physique from a comparative to an asset value. In turn,
the emerging asset character of physique hastens the process of subordi-
nating and containing for, stripped of comparative standards, the im-
portance of physique is diminished, and spread is impeded.
Not all these value changes are to be recommended in all circum-
stances. In regard to physique, we sometimes urge the reverse of "sub-
ordinating," as when we educate our children to appreciate the importance
of good health rather than to neglect it as inconsequential. On the other
hand, there are strong indications that we overvalue certain physical
attributes. Physical fitness is a case in point. It has been noted that there
is "no real evidence in humans that unusual physical fitness imparts
immunity or resistance to disease" (Rusk and Taylor, 1946:199). More-
Value Changes in Acceptance of Disability 137
over, though it is commonly acknowledged that there is a relationship
between physical fitness and ability to work, we know that motivation and
training may be far more important in a particular situation. Similarly,
with respect to containment, the test of reality is always in order. If a
person continues to attempt the impossible through ignorance of the
actual limitations imposed by his disability, overcontainment has occurred.
A more realistic widening of the effects of disability may well be indicated.
The various value changes may be recommended in the following
circumstances:
1. Enlargement of the scope of values is indicated in the case of all-
inclusive suffering where the problem is to see as valuable those aspects
of life not closed to the person.
2. Subordination of values is indicated where the importance of the value
has been overrated.
3. Containment of the effects of disability is indicated where diffuse
spread has occurred and where, on the basis of available fact, the dis-
ability need not have disabling effects.
4. When a value retains substantial importance, as in the case of physique,
what is required for full acceptance is transformation from a compara-
tive to an asset value in situations that do not require a comparison
frame of reference.
It is our judgment that the asset value change is the one par excellence
that will bring about the full and lasting feeling of the dignity of the
individual.
The kernel of feeling epitomizing the state of comparative values on the
one hand and of asset values on the other can be described as, first, "I am
nothing but an incomplete, injured person who has always to mourn his
loss," and in the second case, "I am as I am, and though I don't have all
the possible assets which can be imagined, my life is full" (Dembo,
Leviton, Wright, 7955.-39-40).
Chapter O
Development of the Self-Concept
The kind of person you think yor are becomes endowed with re-
markable powers. It influences, and often decisively, the way one
perceives the intentions of others (see Chap. 7), the choice of associates
(see pp. 40-43), the goals set for oneself (see pp. 24—40), and much
more. The self-concept, then, is an important part of one's world or life
space and has been so recognized by our eminent psychological fore-
fathers who have given serious attention to its development.^ Contem-
porary thinkers are continuing the investigation of this important area.^
In broad outline, we shall attempt here to describe how the concept of
the self is formed and the forces that direct its fate, with particular
reference to problems of disability. That aspect of the self -concept which
pertains to attitudes and experiences involving the body is referred to as
the "body-image."^
The composition of the self-picture is an intricate one, for it is made up
of the variety of personal characteristics that define for the person his
psychological identity: the person develops a notion about his own body,
what satisfactions it gives him and denies him; he discovers that he has
certain interests and abilities, likes and dislikes; he begins to think of him-
self as shy or outgoing or in-between, as irritable, or calm, or anxious; he
learns something of the way in which he affects others, that he is likable
or resented, for example. All these perceptions and evaluations make up
that separate entity in the individual's world variously designated as the
"I," the "me," the "self," and the "ego." For our purposes, no distinctions
between these terms will be made, though some psychologists have made
them. Freud (1933), for example, distinguishes the superego or "con-
1 TTie interested reader is referred to Adler {1924), Freud (1933), Lewin
(1935. 1936), McDougall (1918), and Sullivan (1953).
2Allport (1943), Ausubel (1952), Bronfenbrenner (1951), Lecky (1945),
Murphy (1947), Sherif and Cantril (1947) oflfer critical or integrated accounts
of the development of the self-concept.
3 A broad survey of thought and research concerning body-image phenomena
may be found in Fisher and Cleveland (1958: chap. 1). The authors also
formulate a theory of the "body-image boundary dimension" and describe a
series of research studies, including some dealing with physical disability, which
stemmed from it.
138
Development of the Self-Concept 139
science" of the person from the ego, whereas Sherif and Cantril (1947)
see no need for this separation. Ausubel {1952) makes a distinction
between the body, the self, the ego, and the personaUty.
It is well to keep in mind that the boundary between what is the self
and what is not a part of the self, even in the mature person, is not as
sharp as it might seem. One's children, for example, are felt to be a part
of oneself, though at the same time there is recognition of their independ-
ence. Even an object may become so intimately bound up with the
emotions of a person that, should it become necessary for the two to
become disjoined, as when the person moves from the house in which he
has lived for many years, the person feels that he is leaving behind a
part of himself.
DIFFERENTIATING THE WORLD AND INTEGRATING THE SELF
Journal accounts of the behavior, vocalizations, and verbalizations of
infants and young children have provided some of the earliest source
material for studying how notions about the self are formed. A concise
and well-illustrated review of such accounts has been written by Sherif
and Cantril (1947). Later investigators, notably Piaget (1926, 1932), and
Gesell and Ilg (1943), collected their observations under more controlled
conditions and ordered them systematically.
Psychologists generally agree that the young infant does not make any
distinction between what is himself and what is not. If he should happen
to pull his hair or scratch at his face, he will cry out, but he does not
realize that he is pulling his hair or scratching his face. With the matura-
tion of his nervous system and increased commerce with his environment,
however, differentiation takes place in which there gradually emerges a
very special part of the universe which is felt as the self or "I." For
example, the baby's interest in his hands initially appears to be no different
from his interest in other objects, such as a rattle or crib post. Soon,
however, new experiences emerge. Not only can he control the wiggle in
the fingers but, more than that, he feels the wiggle in a way different from
the wiggle of the rattle. In time he will realize that the hand is a part of
himself whereas the rattle is not. Psychoanalytic theory places special
importance on the physical self both in the differentiation of the person
from other realities and in the continuing development of the ego,
Fenichel (1945), an exponent of the Freudian viewpoint, presents this
emphasis in these words :
In the development of reality the conception of one's own body plays a very
special role. At first there is only the perception of tension, that is, of an
140 Physical Disability — A Psychological Approach
"inside something." Later, with the awareness that an object exists to quiet this
tension, we have an "outside something." One's own body is both at the same
time. Due to the simultaneous occurrence of both outer tactile and inner
sensory data, one's own body becomes something apart from the rest of the
world and thus the discerning of self from nonself is made possible. The sum
of the mental representations of the body and its organs, the so-called body
image, constitutes the idea of I and is of basic importance for the further
formation of the ego [Fenichel, 1945:35-36]A
This process of self-identification is hastened by the fact that the baby
meets resistance in the external world. His needs are not and cannot be
satisfied the moment they arise: it takes time for the bottle to be warmed
and gastrointestinal tensions to subside. The unsatisfied needs not only
sharpen self-awareness but prompt the baby to search for ways to gratify
his needs and, as a consequence, the baby's world becomes yet further
differentiated. It may very well be, as some have asserted, that frustra-
tion is a necessary experience in personality development, for if all needs
could receive immediate gratification, there would be no differentiation
between the self and external reality.
Learning about the self occurs through various modalities. There is, first
of all, the direct sensory experiences of the baby, as when he discovers
the different relations to himself of the hand in contrast to the rattle. Since
vision is presumed to serve more efficiently than the other senses for the
differentiation of external objects from one another, as well as of the self
from other objects, it has been hypothesized that among the congenitally
blind there should be some delay (but not necessarily a permanent defect)
in the development of ego functions (Blank, 1957:1).
Secondly, the child learns about himself through the leads given him by
others. He learns that he is a boy and has a certain name and is an
American, for example. He also develops certain attitudes about these
facts, and therefore about himself, through contact with the viewpoints of
his associates. That the self-concept is a social looking glass expresses the
belief of most psychologists that ideas and feelings about the self emerge
largely as a result of interaction with others.
Not always is the self-knowledge gained directly through the senses
consistent with that socially induced. According to Rogers, when the
person denies the former in favor of the latter, the conditions become
favorable for neurotic ego development (Rogers, 1951: Chap. 11). Part
of the therapeutic process then becomes one of attribution, i.e., notions
about the self must become more correctly ascribed to evidence directly
* By permission from Otto Fenichel, The Psychoanalytic Theory of Neurosis,
New York, W. W. Norton & Company, 1945.
Development of the Self-Concept 141
experienced on the one hand and to evidence socially mediated on the
other.
The fact that knowledge about the self is built up through sensory
experience and through the viewpoints of others, as well as through
inferences based on these sources, makes it possible for the body to become
invested with significance beyond its concretely apprised functions. Body
parts begin to assume such connotations as good and bad, clean and vm-
clean, adequate and inadequate. The hands, for example, may not only
be regarded as tools for grasping and manipulating but also contaminated
by shame and evil should the child have been traumatized when caught
masturbating or in fecal play.
Psychoanalytic theory gives especial prominence to the symbolic mean-
ing of body parts and considers these meanings to be crucial in adjust-
ment to disability. The problem of adjusting to amputations, for example,
is felt to be largely a problem of dealing with castration anxiety. (See pp.
271-272 for a more detailed discussion of this.) Such was the interpreta-
tion given to the following remark of a patient: "Even though the eye is
useless and I will look better with a glass eye I don't want any part of
me cut out" (Blank, 1957:11). When the patient was analyzed within this
theoretical framework it was reported that she mastered the problems of
surgery and the use of the prosthetic eye. Representative of psychoanalytic
theorizing is Blank's analysis of the significance of blindness : "The factors
of particular interest underlying the maladaptations and personality dis-
turbances of the visually handicapped are: (1) The unconscious signifi-
cance of the eye as a sexual organ, including the equation of eye with
mouth and with genital. (2) The unconscious significance of the eye as a
hostile, destructive organ, including the equation of eye with piercing
phallus and with devouring mouth. (3) The unconscious significance of
blindness as castration, a punishment for sin" (Blank, 1957:1). Without
debating the specific symbolic associations attributed to the eyes in this
statement, it is undoubtedly true that the meaning of the body and its
parts has significance that extends far beyond the concrete apprehension
of function and appearance.
The ever-enlarging array of facts and attitudes about the self, whether
or not their symbolism ranges far afield, is not built into the self-picture
in a haphazard way. There is good reason to believe that at least in many
if not all instances, new self-attributes are integrated within old ones
either by modifying the meaning of the former or the latter or both.^ This
sAusubel (1952) apparently would disagree with the generality of this
statement as applied to what he calls "satellization" or the period of dependent
identification of the child with his parents. This "attitude of subservience is an
extremely potent force in value assimilation. It makes possible unquestioning
and unconditional acceptance before any criterion of reasonableness need be
142 Physical Disability — A Psychological Approach
holds true for attributes pertaining to the body as well as those pertaining
to other aspects of the self. In this way a certain stability and consistency
of the self-picture is achieved. This notion is central to such "organismic"
theorists as Goldstein (1939) and Lecky {1945).
The principle of integration through modification of the old and the
new applies, as psychology has clearly established, not only to the self-
concept but to all sorts of perceptions, beliefs, and even behavior. A clear
demonstration of the principle appears in a study in which college subjects
were asked to form an impression of a factory worker on the basis of a
list of traits presented to them (Haire and Grunes, 1950). The inclusion
of "intelligent" as an attribute was disturbing to these subjects, who,
having had a well-organized picture of a working man that was generally
somewhat patronizing and snobbish, found that an intellectual trait did
not easily fit in with their existing system of beliefs and values. They
either had to ignore this trait, tamper with its meaning, or revamp
their total concept of a factory worker. There are many other studies
directly dealing with perceptual and cognitive phenomena that show the
interacting process between part and whole in the service of integration.
Returning to the self, we get a glimpse of the process of differentiation
and integration with specific reference to body image in the following
account. Billy was born without arms. Attached to his right shoulder was
a small part of a palm and three tiny fingers, and to his left shoulder
were two webbed appendages. When Billy was about two years old, he
was led to believe, through discussion he had heard from time to time
about his body as well as information gained through his own senses, that
his right hand, with which he could feed himself and hold things, was his
good hand, whereas his left hand, which was practically useless, was his
broken hand. The development of this perception is seen in the following
incident told by his mother:
... in the playground, one of the children noticed Billy's lack of arms for
the first time and kept asking over and over if his arm had broken ofif. He was
too little to understand a real explanation so I finally said, yes, it had broken
off, and walked away. I thought no more about it, because similar incidents had
happened so often, until that night when I was giving Billy his bath. He felt
his little two fingers that protrude from his left shoulder anxiously, as if to
reassure himself that he, too, has something there. Then he held up his right
arm and said, "This good hand, other broken hand" [Bruckner, 1954:\4Q].^
satisfied" (p. 137). In our judgment, integration need not require a reasonable-
ness that adheres to adult logic, but is rather a "fitting-in process" in which new
facts or attitudes or values are assimilated by being attached to existing beliefs
so that the old and the new cohere as a Gestalt.
6 Leona S. Bruckner, Triumph of Love. New York. Simon and Schuster, Inc..
1954. By permission.
Development of the Self-Concept 143
Sometime later Billy denied not having an elbow because (and we
interpret) this fact was simply inconsistent with his existing belief that
his right hand was his good hand :
One day as she [Karen, Billy's sister] was doing something, and Billy was
trying to copy her, she noticed that he could not do it. She looked truly sur-
prised as she said, "Mother, I just noticed that Billy doesn't have an elbow and
he can't lift his hand up high like I can."
I hadn't thought that Billy had heard her because he was so absorbed in
what he was trying to do. But he immediately answered her.
"I do so have an elbow and look at me lift my hand up high. See, Karen"
[Bruckner, 1954:146-147].
It is certain that once Billy learns more precisely what an elbow is, he
will recognize its absence in his own anatomy, but once having perceived
this, other changes in his self-picture will take place in order to effect
the necessary integration. He may realize, for example, that his right
hand is not, in fact, a "good hand"; though it is better than his left, it
still has major shortcomings. How this will affect other attributes of his
self-concept, his self-esteem in particular, will depend upon the further
direction the integrating forces take. We shall have more to say about
this shortly.
At this point it is important to note that the principle of integration
need not imply a self-picture that is integrated in all its aspects. The
findings of one study, for example, suggest that the ideal self is a complex
rather than a unitary entity, making it possible for inconsistencies to
persist without tension (McKenna, Hofstaetter, and O'Connor, 1956).
It is more than likely that not only the ideal self but also the self in its
existing structure consists of subparts, each of which may be fairly well
integrated but not necessarily related to every other part in an integrated
way. For example, Mr. A. may consider himself a handsome man but a
scoundrel: his appearance self and moral-behavior self are relatively
independent, by which we mean that a change in either of these subparts
of the self has little effect on the other. Subparts, however, may show a
high degree of interdependence and therefore integration, as when a
person feels himself a scoundrel because he is repulsed by his appearance.
We believe that personality descriptions in terms of the relatedness of
subparts of the self would provide pertinent data about the individual.
Schilder (1953) asserts "that single sensations [about the body] do not
stand helter-skelter side by side in memory, but are ordered into a total
image of the body — or, to use Head's expression, into a schema. Every
new stimulus is met by previously fixed structures, by a body-image . . ."
(p. 93). Our only difference with this point of view is to take the more
144 Physical Disability — A Psychological Approach
moderate position that integration of a new stimulus or sensation need
not require ordering into a total image of the body, but rather a subpart
may be sufficient.
INTEGRATION AND SELF-EVALUATION
A Two- Way Process
One of the most interesting and direful facts about the integrating
process is that frequently congruency is established between what we
might call a single attribute of the self on the one hand and self-esteem on
the other. This fact has been encountered earlier in the discussion of the
phenomenon of spread (see pp. 118-119). Self-esteem refers to the more
or less general evaluation by an individual of himself as a worthy or un-
worthy person. The perception of a single attribute may be molded by
self -evaluation, or the evaluation of the self may be affected by a single
attribute in such a way as to bring about the necessary integration.
Both processes may occur, and both are seen very clearly in Raymond
Goldman's (1947) life history. It may be recalled that Raymond was the
boy whose legs became disabled from infantile paralysis at the age of 4,
and who in his teen years struggled against increasing deafness. The first
example shows that even what objectively may be a startlingly clear and
unambiguous fact concerning the self, namely the gross condition of one's
legs, may be distorted by the power of the general evaluation of the self.
The scene is the doctor's office where 8-year-old Raymond is waiting to
have long leg braces fitted. His self-esteem at this time glistened with the
high and mighty omnipotence of a childish ego. All along he had been
king-pin in a world in which he had been loved and lauded and protected:
Most of the seats were occupied by waiting patients and their mothers. It was
the first time I had ever been close to a large group of children — there were
about ten or twelve in the room — and I regarded them with curiosity. They
were all crippled and deformed, and I saw what braces were like. There were
different kinds. The little girl who sat across from me wore one on her head. It
protruded from the neck of her dress in the back and ended in padded circular
fingers that gripped either side of her head just above the ears. When she
wanted to look to one side or the other she had to turn her whole body from
the waist. TTie boy who sat beside her wore braces on his legs as did nearly all
the children. But each brace differed from the others and I wondered what my
braces would be. Did they hurt? I wanted to ask the boy who sat next to me,
but so deep a hush lay over the room that I did not dare. . . .
I preferred looking at the folding doors to looking at the children. I couldn't
bear the sight of them; they were ugly and sickening. I almost hated them.
ITieir legs were thin and misshappen. TTieir faces, somehow, were too old and
Development of the Self -Concept 145
wise. I felt that way, not realizing that I was there as one of them. [Italics
added.] If someone had reminded me that my legs were thin and deformed,
dangling there helplessly from the edge of the chair, and that my face, perhaps,
revealed a kind of wisdom that only long, deep suffering can impart, I would
have been shocked [Goldman, 7947:24].''
Even though Raymond could not walk and pain was still a frequent
intruder, even though he had watched other children run and play, a
deformed body image was simply out of keeping with his self -evaluation
as a lovable and powerful person. Integration between these two attributes
of the self was achieved by not recognizing on the conscious level that
his body was deformed! There is some evidence, however, that sub-
consciously Raymond was aware of his own deformity, and in fact hated
it. For example, the deep aversion he felt toward the other crippled chil-
dren in the doctor's office seems explicable on the basis of such awareness.
The next example shows both how a single attribute is molded by
self-evaluation and, conversely, how the perceived attribute, through its
evaluatory connotations, largely determines the person's self-esteem. The
following incident took place a short time after Raymond's visit to the
doctor (previous incident). It is Raymond's first day at school:
I finished my lunch and dropped the remains into the can that I was able to
reach. Other boys came to drop their refuse in the can. One of them stopped to
look me over.
"What's the matter with you?" he asked me.
"Nothing," I said.
"Can't you walk?"
"I can walk a little," I said. "I can crawl real fast, though."
"Jiminy Christmas!" he exclaimed.
I took this to be an expression of admiration. I looked up into his face, eager
to be friendly. No one else had spoken to me, though many had looked at me
intently, and I was grateful for this attention.
We attracted the attention of other boys and soon a crowd was gathered in
a semicircle around us.
"Lemme see, will you?"
"Quit shoving or I'll — "
"This kid can't walk. He says he can crawl real fast though."
I was pleased and honored. It was like one of my dreams.
"I can even crawl up and down steps," I told them. "They won't let me crawl
here because I'd get dirty."
The boys began to laugh. I wondered what was funny about that statement.
Through my mind flashed the weeks and weeks of efforts before that feat had
'^ Selection from Raymond Goldman, Even the Night, copyright 1947, The
MacmiUan Company, is used with the permission of the publisher.
146 Physical Disability — A Psychological Approach
been accomplished. Now my boast — and I had really said it boastingly — was
greeted with laughter.
"That's pretty good, fellas! He can crawl up and down steps!"
I felt easier when I heard that. So they did think it was pretty good! Their
laughter, then, had been prompted by admiration.
One of the boys leaned down and touched my leg. He circled it with thumb
and forefinger.
"Look how skinny!" he shouted triumphantly. "I can wrap it with two
fingers!"
"Let's see!"
"Sure 'nough!"
"Gee, what skinny old legs!"
A feeling of inferiority began to batter against the bulwark of my illusions.
I sensed the ridicule before I comprehended it. I had never been fully conscious
of the fact that my legs were emaciated. Now I looked down at them and then
at the legs of the other boys. The damnable hammer of comparison beat the
truth into my consciousness.
"Let go my leg!" I said, letting anger rise to cover rising horror.
"Why? Does it hurt?"
"No. But let it go."
"Who says so?" the boy demanded, but he released my leg and stood up.
"Let's see you crawl."
"No."
"Jiminy!" he said. "Those ain't legs. You got broomsticks!"
That prompted another sally of laughter. The room echoed a jeering repeti-
tion of "Broomsticks!" I looked at my tormentors with burning eyes. I saw
them through a film of tears. T wanted to kill every one of them, to hit them
and claw them and bite them. In my hand was an imaginary dagger, sharp and
glistening. I saw myself leaping from the bench and slashing right and left with
the murderous blade. My victims screamed and fell, bleeding, dead at my feet.
TTie boy — perhaps it was the same one — reached down and grasped my leg
again. I flung myself forward off the bench, grabbing him as I fell. The boy
went over backward and we went down with me on top. I heard his head hit
the concrete and I was glad. I sat astride him, pounding my fists into his face,
screaming with tears streaming down my face.
Then I felt myself being lifted up while my fists were still flailing.
"Stop it! Stop it! Behave yourself, Raymond!"
I suddenly realized that it was Mr. Stevens' [the principal's] voice and that
I was on his arm. I buried my face in his shoulder and sobbed [Goldman,
7947;35-37].
Following this incident Raymond Goldman was a changed person. "A
few ill-mannered boys had implanted in me the seed of shame from which
I was to conceive a monster" (p. 38). Thereafter, until more maturing
forces took hold, Raymond suffered the hurt and shame of inferiority. The
perception of a single attribute, that his legs were deformed, had the
Development of the Self-Concept 147
power to annihilate fairly thoroughly the general esteem he had hereto-
fore felt.
If we examine the foregoing incident in order to reveal more explicitly
what was happening in the process of alignment between attribute and
self-evaluation, three phases may conveniently be distinguished:
1. Self-evaluation dominates perception. When Raymond went into the
lunchroom, he felt proud of himself and his accomplishments. Ambiguous
social events were integrated within this scheme and interpreted accord-
ingly. Thus, when Raymond became the center of attention through
staring and queries, he basked in illusory glory, for was not all this
admiration over the wonder that he was?
2. There is temporary incongruence between self-evaluation and out-
side events. Then the boys began to laugh. To Raymond the laughter was
puzzling, for it seemed inappropriate for a hero who, by dint of sheer
perseverance, had accomplished so great a feat as crawling. But his self-
esteem remained unshaken and his uneasiness allayed when that segment
of the comments made by the boys that could be seen as consistent with
his high self-regard was partialed out; he latched onto the statement,
"That's pretty good, fellas! He can crawl up and down steps!" Raymond
was then again able to interpret the laughter as being prompted by
admiration, the laughter being suflBciently ambiguous to be fitted into the
pattern of his highly valued self.
3. Single attribute dominates self -evaluation. Then came the turning
point when the events outside Raymond's skin were not so malleable. The
children pointed out how skinny his legs were, that two fingers could
wrap around them, and that they were broomsticks. What is more, they
were unrelenting in their ieers until Raymond was all but bludgeoned into
perceiving the stigmatizing aspects of his physique. We would like to
speculate as to what might have gone on in Raymond's mind as these
invectives were being hurled at him:
They call my legs skinny, and broomsticks. They are not skinny! I can
prove that they are as stout and shapely as anybody's. See — look at mine and
look at yours. Oh no! They are skinny! They are broomsticks! I have broom-
sticks for legs. You shouldn't have broomsticks for legs. They asked me if I can
walk. I can't walk but I can crawl. That's just as good as walking. No it isn't
I should be able to walk. I'm ashamed. It's awful. It's horrible!
Notice that, before Raymond's new perception of his legs could affect
his self-esteem, the perception had to take on an evaluative quality of
good and bad, what should be and what should not be. Although Ray-
mond sensed the ridicule before he could comprehend it, the ridicule had
148 Physical Disabilify — A Psychological Approach
the power to bewilder but not to shame until the ridicule became attached
to his own perceptions of what should be and what should not be.
Integration then took place along many paths: fact with fact — Ray-
mond perceived his legs as broomsticks. Fact with value — he perceived
that his legs should be stout and shapely and not like broomsticks.
Evaluated fact with self-esteem — he perceived his self as inferior in
keeping with an inadequate physique.
The integrative process is one reason why the self-concept is difficult
to change. The very thing that is to be changed has considerable power
in molding the experiences impinging on the person to fit its own image so
that they are interpreted as not conflicting with that self-concept. It takes
a lot of convincing before a drastic remodeling of the self-concept can
take place in either a negative or positive direction (Rogers, 1951). Just
as Raymond had to be "bludgeoned" into perceiving the abnormalities of
his physique, so it took years of internal struggle before he became con-
vinced that he was still a man for all that.
The resistance against positive change in the self-concept is especially
interesting since it runs counter to what would seem to be the wishes of
the person. Would not everyone rather feel better about himself? The
resistance, however, is simply one of the consequences of the integrating
process. Once self-abnegation involving the total person has taken place,
then the old and new events tend to be interpreted in harmony with a
negative self -concept. Raymond, for example, could no longer really think
of his performance as accomplishments because such an evaluation, which
previously had fitted in well with his high self-regard, now had nothing
to which it could be anchored. In the same way a foreigner who feels
ashamed because of his place of birth sees primarly what to him are the
devaluating features of his extraction such as poverty or poor education,
to the exclusion of possibly worthy aspects, such as good culture and
diligence. The therapeutic problem involves identifying the worthy aspects
of the upsetting characteristic in question, of giving them sufficient weight
to effect a change in self-concept, and of reintegrating the negative
features accordingly. This process may be designated as the principle
of positive identification. Concretely, in the case of disability, it means
highlighting and identifying with the coping aspects of the disability
(see Chap. 3).
Two Gradients in the Spread from Single Attribute to Self-Evaluation
Once again we encounter the phenomenon of spread, and once again
we raise the question of how a single fact about a person can become so
potent as to print its negative (or positive) stamp on the person as a
whole. Previously, this phenomenon was related to the "halo effect" (see
Development of the Self-Concept 149
p. 121) and to "comparative values" (see pp. 131-132). Here we should
like to approach the problem from the point of view of the structure of
the self-concept by isolating two general factors — namely, the "self-
connection gradient" and the "status-value" gradient.
SELF-CONNECTION GRADIENT. It is known that attributes of the
self differ with respect to how central they are to what may be called the
"essence of the self" or the "essential me." One's blood type, for example,
typically is quite alien to this central core, whereas one's ability and ap-
pearance are typically very close. A close connection between the attribute
in question and the self-core is often expressed by the verb "to be," as in
the following: I am smart; you are good-looking; he is dishonest. A
weaker connection is often expressed by the verb "to have," as in the
following: I have false teeth; you have a clear complexion; he has fine
motor coordination.
What makes for closer or weaker connections with the self-core is a
challenging problem requiring further investigation. A few leads are,
however, immediately apparent, several of them directly related to what
has been called ego-involvement. From the perceptual point of view, it
appears that events involving the face and torso are more closely con-
nected with self-essence than events connected with the appendages. Thus
it is to be expected that adjustment to a facial disfigurement would in
general involve a greater problem from the point of view of the self-
connection gradient than adjustment to a leg disfigurement, for example.
This is also at least one reason why we speak of a girl as being pretty if
her face is pretty but not generally if her hands are pretty. The face
seems to be a more intimate part of the person than the hands or legs.
How close the identification between face and self can be is seen in the
case of a little boy who feared that if he wore glasses nobody would
know him.
Evidently, too, there is less connection with the self -core when a body
attribute may be looked upon as a tool than when it is looked upon as a
personal characteristic (Dembo, Leviton, Wright, 1956:22). For example,
false teeth may be thought of as a tool for eating, albeit inferior to the
original equipment, or they may be thought of as bespeaking one's
decline — i.e., as a personal characteristic.
Also, certain personal characteristics about the self appear to be more
crucial to one's identification than others. People identify themselves as
men or women, for example, and not as broad-headed or long-headed.
Since sex identification is often a central personal characteristic that serves
to define the person to himself and others, it can be expected that any
circumstance that alters or endangers this identification will have marked
effects on the self-concept. The same little boy who faced the prospect of
wearing glasses expressed the fear that he could not be a rough-and-
150 Physical Disability — A Psychological Approach
tumble boy any more, an a priori connection which, threatening the
child's sex identification, made him envision himself as a strangely dif-
ferent person.
To take another example, leg amputation is sometimes viewed as a
symbol of castration. Feeling "half a man" points to one of the main areas
of adjustment, an area that often has wider implications for personal well-
being than the sheer ability to get around. In one intensive study on the
role of sexual impotence in the concept of self in male paraplegics, it was
pointed out that, compared to nonimpotent male paraplegics, the impotent
group appeared less adjusted to their disability and more upset in almost
all other areas of their personality (Berger, 1951). Parenthetically, we
should like to say that this study deals almost solely with succumbing
aspects of paraplegia, carefully detailing the personal and interpersonal
disturbances effected by the physical trauma, as if the concept of self does
not have anything to do with the strivings of the person, with his efforts
to meet the impact of his disability. In the personality sketches drawn for
the 30 subjects there is no mention of any constructive forces, of the
resources within the patient that will enable him to cope adequately, of
what the patient is "becoming," to use the expression of Gordon Allport.
Another personal characteristic high on the self-connection gradient is
often symbolized by the kind of work one does. One's very essence may
be felt to be that of a scholar, a miner, or a musician. The self-concept,
then, might be expected to suffer stress when circumstances — retirement
or injury, for example — force one to give up the work. Preparing for
retirement in advance means reshaping the self-concept to fit a new role.
If adjustment is to take place, other personal, positive attributes must
assume a high position on the self-connection gradient. Unfortunately,
the science and practice of mental health have not as yet seen the equal
necessity of preparing for disablement.
Personal characteristics, of course, carry with them status implications.
But independent of the status value of a personal characteristic, there is
variation as to its connection with the self-core. This point is clarified in
the following section, which deals with the status-value gradient.
An examination of cases in which the body becomes so detached from
the self that it is looked upon or felt to be an object is revealing. For
instance, Bettelheim (/945.-431) reports that as a Nazi prisoner he was
able to endure the torture and indignities inflicted upon him because right
from the beginning he became convinced that these horrible and degrading
experiences somehow did not happen to him as a subject, but only to him
as an object. There is also a psychotic separation between the body and
the self in which the person disowns the body as not being his or as
belonging to another person. A more familiar example of body-person
separation is the physician who, examining a patient, maneuvers him and
Development of the Self-Concept 151
treats him as he would any other object coming under serious scrutiny.
For him, physique has been removed from any connection with feelings,
attitudes, or essence of the other person's self.
In this last example, the separation is effected in a second individual,
the physician, rather than in the person himself. Undoubtedly, body-self
separation occurs less readily in the person himself than in the second
person who, intentionally or not, more easily remains cut off from the
personal qualities of the former. Thus it is that without qualms a stranger
can stare at a person with a disability just because this person is, for him,
an object of his attention. Should their eyes meet, the body-person separa-
tion is destroyed, for "eyes are the mirror of the soul," and the stranger
looks away.
It is also noteworthy that the person himself resists such separation all
the more when it denotes a loss of integrity of the "essential self." He
resents being stared at when he feels "like a monkey in a zoo." On the
other hand, in the case of the prisoner, he could maintain integrity only
by dissociating his body from his self-core.
In terms of adjustment to disability, clinical records indicate that dis-
owning the defective part is deleterious to the goals of rehabilitation. The
person who feels psychologically that the withered limb is not a part of
himself will not be able to make most effective use of it. In this connec-
tion, a study of patients with facial disfigurements (Macgregor, et al.,
1953) indicated that persons reared not to mention and to otherwise
hide their deformity never integrated it well into the body image, whereas
those who were reared to regard the deformity realistically were able to
give a fairly accurate description of themselves. Moreover "a poorly
integrated deformity seemed to favor dissatisfaction with the operative
result, whereas a clear concept of the body image seemed rather to pre-
dispose to postoperative satisfaction" (p. 199). Similarly, a study of
amputees has shown that an individual's adjustment to a prosthesis is
dependent to a considerable degree upon his self -concept (Fishman,
1949).
The disability must become an integrated part of the self, not severed
from it, though research will have to show whether its optimum position
on the self-connection gradient is at a distance from or closer to the self-
core. Clearly, the development of theory and research is also needed to
identify further the conditions determining position on this gradient.
STATUS- VALUE GRADIENT. Attributes also vary with respect to
their relevance for the evaluation of personal worth or self-esteem. In the
American culture, for example, success and achievement commonly have
a higher loading of status value than diligence or cooperation. One of the
determiners of status value may very well turn out to be the degree of
connection with the self-core (as well as vice versa), but undoubtedly
152 Physical Disability — A Psychological Approach
there are other determiners as well, for the relative status value of two
attributes may sometimes be the reverse of their position on the self-
connection gradient. Thus, a man may enjoy high status because of his
political influence rather than ostracism because of his reprehensible
character, even though this second attribute may be more tied in with the
core of the self than the first.
In the preceding chapter, several value changes were discussed that
have the potentiality of reducing the status value of physique: enlarging
the scope of values, containing disability effects, subordinating physique,
considering physique as an asset value. Also, perceiving the coping aspects
of a disability in contrast to its succumbing aspects has significantly dif-
ferent effects on its status value (Chap. 3, p. 59).
When the effects of disability are felt to be widespread, it would seem
that the disability has greater possibilities of assuming a high position on
both gradients. At the same time one has to be most cautious in conclud-
ing that a severe disability will automatically have a more drastic conse-
quence on the perception of self than a mild one. An excellent example of
more than a minor disability having a relatively insignificant effect on the
perception of the person (though it deals with interpersonal perception
rather than self -perception) occurred when a father, confronted with the
news that his son lost a leg, rebutted:
"Lost a leg, has he? What's so bad about that? Rest of him's in good shape,
hain't it?" [Viscardi, 1952:143]^
And as we have seen in the example of eyeglasses presented in the pre-
ceding section, even a mild disability may affect areas in the person's life
that are closely tied to his self -core and important to his status.
In answer to the original question concerning how an evaluation of a
single attribute becomes imposed on the evaluation of the total person,
we may now stipulate two functions. The power of a single attribute to
influence self-esteem will be greater ( 1 ) the closer the connection between
it and the self-core, and (2) the higher the status value it possesses.
Two conclusions follow. First, since a disability is a negatively evaluated
condition, and since physique almost always has some connection with
the self-core (though in specific cases its position on the self -connection
gradient may be low) and since physique in most cases has some status-
value relevancy (though in some cases a low value) for most people self-
esteem will be threatened by disability. Because of the danger of false
generalizations, we must note that this conclusion does not state that
8 Henry Viscardi, Jr., A Man's Stature. Copyright, 1952, by Henry Viscardi,
Jr. Used with permission of The John Day Company.
Development of the Self-Concept 153
persons with disabilities tend to feel more inferior than the able-bodied,
for, of course the able-bodied may also feel inferior about particular
attributes (see pp. 52-56).
Secondly, though shame stemming from the negatively evaluated
aspects of disability ordinarily must be experienced, such shame can be
but a tiny voice in a chorus whose main themes speak of the coping
aspects of the situation. When the coping aspects are attended to, new
positively evaluated attributes will appear which, through the principle of
positive identification, establish high positions on the self-connection and
status-value gradients, thereby building up self-esteem. For example, the
person may feel proud because he has managed to earn a living in spite of
severe handicaps. Such personal attributes as perseverance, independence,
intelligence, moral stamina, etc., may give genuine support to an ego
that may be undermined by the negatively evaluated attributes of the dis-
ability itself.
AGE OF OCCURRENCE OF DISABILITY
During the life of an individual, the body, of course, undergoes change.
It grows, matures, and ages. The change may occur gradually, as during
childhood and adulthood, or more suddenly, as during adolescence or as a
result of disability.
Before raising the question of what happens to the self-concept when
there is a sudden change in physique, it should be realized that typically
even a gradual change is first consciously recognized not gradually but
all at once as a sudden and startling fact. This occurs when the meaning
of the changing physical trait is of such a nature as to effect major modi-
fications in the self-concept. Thus the wrinkles and the greying hair that
had been accumulating over a period of time may not even be perceived
until the person suddenly realizes, "I am getting middle-aged!" To take
another example, many an adult remains happily unaware of what to
others is an unmistakable increase in weight, interpreting their blunt
remarks as inconsequential and meaningless jests, until he is shocked into
the realization, "I am fat. Is that I? I once was so slender and youthful.
It couldn't be."
Often, however, what are looked upon as major changes or "turning
points" in a lifetime are brought about by special events that significantly
alter the self-concept. Marriage, parenthood, graduation, victory or
defeat in important areas, commonly represent such events. Raymond
Goldman's first day at school was a turning point for the same reason (see
pp. 145-147). Subjectively, the person may feel a strangeness about him-
self, a kind of unfamiliarity, and more extremely he may feel like a dif-
154 Physical Disability — A Psychological Approach
ferent person. Ordinarily, however, he still recognizes himself as the same
person in spite of remarkable changes. The property of integration, which
requires that the new feelings and notions about the self be absorbed
within the old ones (see pp. 139-148), makes possible the feeling of
continuity between the past and the present in a life history. It is this
property which cautions us against the generalization that a physical
trauma, even a major one, must create a violent upheaval in the self-
concept.
Because of man's tremendous need to simplify so that he can under-
stand, generalizations continue to be made to the effect that it is easier to
adjust to a disability when one is "born that way," or when it is acquired
in childhood, or in adulthood. There are several good arguments for each
of these alternatives. In the case of congenital disability, one does not
have to cope with alteration in the self-concept and therefore on this score
adjustment is facilitated. On the other hand, in the case of adventitious
disability one is not faced with the possible stigma of hereditary defect.
Also, one could argue that the adult is better able to adjust to a disability
because of his greater maturity, in contrast to the child, who is more
vulnerable; or the reverse could be stated — namely, that the child, being
more plastic than the adult, can more easily accommodate changes in his
self-perception. One could add that the child is not burdened with earning
a living and with the heavy demands for independence that confront the
adult. Also, one could point out special psychological stages in the life
cycle that affect adjustment to disability incurred at that time. Thus, on
the basis of certain phases of psychosexual development, the conclusion
has been stated that "all other factors being equal, we expect blindness
occurring at age nine or ten to be less traumatic to the ego than at age
five or age thirteen" (Blank, 1957:11).
Probably all the aforementioned factors, as well as others, bear upon
adjustment to disability. But evidently their weighting or correlation with
age varies with the groups studied, for research has simply not shown with
any consistency that adjustment to disability is easier or more difficult at
certain ages of incurrence than at others. The overall status of the findings
in regard to deafness may be taken as representative of research with
other disabilities. Barker et al. (1953) summarize 13 studies analyz-
ing adjustment in terms of age at loss of hearing with the statement
that the findings of these studies are inconsistent. "A few tend to show
greater problems of adjustment when loss of hearing occurs at young ages;
others tend to show the reverse. Most of the relationships are statistically
unreliable" (p. 233). Even though, in the case of hearing, loss at an early
age carries with it the special and difficult problem of learning language,
nonetheless age of onset as such does not appear to be a crucial factor
governing the psychological outcome of the adjustment process.
Developmenf of the Self-Concept 155
The fact remains, however, that a disability incurred after the self-
concept has already achieved some structure requires that the new state
be integrated within the old notions about the self. In a study dealing
explicitly with the effect of disability on the self -concept, Shelsky (1957)
asked his subjects to describe themselves as they were before the dis-
ability and as at the time of the survey. The particular disabilities involved
were tuberculosis and amputation. All the subjects were adults, still
hospitalized, and were examined at least two months posttrauma, the
average length of time since determination of the disability being about six
months. He found that both groups of patients did recognize some dif-
ference between their present and past selves but far less than one might
have expected. The amputees described themselves as having been more
active, adventurous, and energetic, and less awkward than they were at
present, these being realistic perceptions of the effects of loss of a limb.
This realism is also seen in the perceptions of the tuberculous patients as
having previously been more healthy and active. They also saw themselves
as having been more foolish, impulsive, and hurried than at present.
It seems that these subjects did not, at least on the conscious level,
experience any violent upheaval of the way they perceived themselves as
persons. Of 300 possible traits, including such commonly assumed dis-
ability-related characteristics as anxious, complaining, confused, dis-
satisfied, high-strung, irritable, moody, nervous — or, to take a sample of
positive attributes, adaptable, contented, courageous, enterprising, and
inventive — the subjects evidently felt that only a very few differentiated
their former from their present selves. For the most part, the acknowl-
edged changes related to realistic and very clearly disability-linked attri-
butes. Moreover, the results did not show these changes to have major
consequences for traits not directly related to the disability or for one's
general self-evaluation as expressed by such feelings as contented, capable,
self-confident, etc. — at least not on the conscious level.
One could reasonably argue that effects on the personality as a whole
and on the less obviously involved personality areas were repressed or
that such effects require more time to become apparent than these recently
involved patients had. Also, one could question the advisability of con-
sidering a group of persons who have a disability in common as psycho-
logically homogeneous, since real consequences for the self-concept may
be obliterated by the intragroup variability. As a matter of fact, the
process of integration makes certain that there will be a significant rela-
tion between emotional reactions to disability and the premorbid person-
ality with corresponding differential effects on the self-concept which, if
added together, may well cancel each other out. In a study of tuberculous
patients, for instance, Wittkower {1949) points out that for conscientious
individuals to be ill, unfit, and dependent tends to be incompatible with
156 Physical Disability — A Psychological Approach
high and rigid self-imposed standards of fitness and social responsibility.
Dependent persons, on the other hand, seem to feel no urgency to get
better. As for rebellious individuals, their resentment at fate and confine-
ment may more or less obliterate immediate concern about the illness. If
the diverse personalities were treated as a single group, one could see how
these differential reactions could become buried in the statistical treatment.
In support of the principle that age as such is a poor psychological
index of the effects of physical trauma on the self-concept and that
personality factors already formed are the important variables, Bard
(1952), referring to emotional reactions in radical mastectomy patients,
concludes :
It is true that the loss of a breast constitutes a blow to femininity, but
femininity has a different meaning to each woman. To the patient who is extra-
maritally promiscuous, femininity means something quite different than it does
to the woman who is as yet chaste and unmarried at a relatively late age. The
statement that postclimacteric women will have a more emotionally tranquil
course than will younger women who have not fulfilled their goals of marriage
and motherhood is an equally meaningless generality since the breast acquires
individual meaning to each woman based on her resolution of fears pertaining
to the achievement of heterosexuality and motherhood. Some women integrate
the breast into a framework of self-esteem in feminine function. Others, on the
other hand, integrate the breast as a defense against a feeling of worthlessness
as women. These resolutions and defenses are active throughout the life of the
woman and do not mysteriously disappear with menopause. The impact of
breast amputation upon a woman, therefore, will depend less on her age than
upon the character defenses which it disrupts [p. 1 147].
Just how traumatic to different kinds of personalities is the advent of a
major disability we do not know. In a study of facial deformities, Mac-
gregor et al. (1953) mention that "disfigurement which occurred during
adulthood always seemed to have a disorganizing effect on the integration
of the person" (p. 195). But to what extent for different personalities is
an important psychological question.
It may be that more often than even wishful thinking would allow man
absorbs the fact of a disability in such a way as to keep the major outlines
of himself as a person intact. There is good reason to believe that the kind
of person one is as differentiated in the self-concept has a stability that
resists a general overhaul (see p. 148). Because new experiences are partly
and sometimes largely interpreted in terms of the existing self-concept, it
is not surprising that damage to the body can also be accommodated
within this framework.
Yet where the essential "I" is inextricably associated with the intact
body and where the status value of body-whole, body-well, and body-
Development o'f the Self-Concept 1 57
beautiful is high, traumatic consequences for the self-concept appear in-
evitable. In fact, the consequences may be so traumatic that the person
may be unable to integrate his new physique into the self-concept at all.
This anguished difficulty is effectively described by Katherine Butler
Hathaway (1943), who suffered from a tubercular infection of the spine
and was bedridden throughout her middle childhood:
When I got up at last . . . and had learned to walk again, one day I took a
hand glass and went to a long mirror to look at myself, and I went alone. I
didn't want anyone ... to know how I felt when I saw myself for the first
time. But there was no noise, no outcry; I didn't scream with rage when I
saw myself. I just felt numb. That person in the mirror couldn't be me. I felt
inside like a healthy, ordinary, lucky person — oh, not like the one in the
mirror! Yet when I turned my face to the mirror there were my own eyes
looking back, hot with shame . . . when I did not cry or make any sound, it
became impossible that I should speak of it to anyone, and the confusion and
the panic of my discovery were locked inside me then and there, to be faced
alone, for a very long time to come (p. 41).
Over and over I forgot what I had seen in the mirror. It could not penetrate
into the interior of my mind and become an integral part of me. I felt as if it
had nothing to do with me; it was only a disguise. But it was not the kind of
disguise which is put on voluntarily by the person who wears it, and which is
intended to confuse other people as to one's identity. My disguise had been
put on me without my consent or knowledge like the ones in fairy tales, and
it was I myself who was confused by it, as to my own identity. I looked in the
mirror, and was horror-struck because I did not recognize myself. In the place
where I was standing, with that persistent romantic elation in me, as if I were
a favored fortunate person to whom everything was possible, I saw a stranger,
a little, pitiable, hideous figure, and a face that became, as I stared at it, painful
and blushing with shame. It was only a disguise, but it was on me, for life. It
was there, it was there, it was real. Every one of those encounters was like a
blow on the head. They left me dazed and dumb and senseless every time, until
slowly and stubbornly my robust persistent illusion of well-being and of
personal beauty spread all through me again, and I forgot the irrelevant reality
and was all unprepared and vulnerable again [pp. 46-47]. ^
And yet the person cannot comfortably remain one kind of person '
when "looking in the mirror" and another kind of person when he is able
to suppress the disturbing facts of his physical self. The integration that
will allow the person to continue to think well of himself, however,
requires important reevaluation of physique as a value (Chap. 5) with
concomitant changes on the two gradients described in the present
chapter.
9 K. B. Hathaway, The Little Locksmith, copyright 1943, Coward-McCann,
Inc. By permission.
158 Physical Disability — A Psychological Approach
CONCLUSIONS FOR CHILD-REARING PRACTICES
We have attempted to give some indication of the processes of dif-
ferentiation and integration in the development of the self-concept and
how self-evaluation and the evaluation of a single attribute become
reconciled. Now we shall consider the problem of self -evaluation and
integration from the point of view of the prevention of psychological
trauma:
Using Raymond Goldman's (1947) childhood as an example, we might
agree that the following were undesirable:
1. Raymond's denial of his own deformities during the period in which
he regarded himself as a paragon.
2. Raymond's denial of his own worth at the time when he was forced to
recognize the disabling and pitiful aspects of his disability.
Each of these defied the evidence of reality. That the first occurred was
a good guarantee that the second would occur also, because it indicated
that the disability as a negatively evaluated fact could not be assimilated
into the self-concept without threatening it. To avoid this, gross distortion
became necessary. The inevitable occurred, however, when Raymond's
schoolmates denied him the bliss of his pretense and insisted that he
acknowledge the inferiority of his legs. What had heretofore been a stable
and high self-esteem gave way to an even more undeniable reality; his self-
esteem plummeted and shattered to the depths of despair and shame. Ray-
mond's "wakening to shame and the consciousness of reality was inevita-
ble. If it had not happened that day under those circumstances, then it
would have happened another day under other circumstances" (p. 38).
We should like to ask in what circumstances would Raymond have been
better prepared to face his deviations without having had to pay the price
of his sense of persona! worth. The main principle offered is that negative
or devaluating aspects of disability must be brought to the young person's
awareness, along with the coping aspects, by those who know and love
him. This principle may be referred to as realization amid interpersonal
acceptance. Accordingly, it was important for Raymond to have talked
and thought about the fact that his legs were in fact emaciated and in-
ferior to those of most children in order that he could have relegated
these devaluating aspects to a position of relative impotence by feeling
and understanding that he was loved and accepted in spite of his crippling.
In terms of the previously described self-connection gradient, this would
mean that the devaluating aspects of physique became further removed
from the self-core: "I and my crippling are not the same because I am
loved though my legs leave something to be desired." A comparable shift
on the status-value gradient, especially if accompanied by the value
Development of the Self-Concept 159
changes described in the preceding chapter, permits a healthful integration
of the disability into the self-concept.
The principle of realization amid interpersonal acceptance is best
effected when the person close to the child discusses disability-connected
matters in the framework of their coping aspects and in situations where
this topic comes up naturally. Lowenfeld (7956) advises parents of blind
children as follows:
. . . When he [your child] has recognized that he cannot see, he may ask you
why this is so. If you tell him that he is blind because his eyes do not work, but
that he has his hands with which he can feel, his ears with which he can hear,
his nose with which he can smell, and his tongue with which he can taste, his
attention will be focused on what he can do rather than on what he cannot do.
Telling him alone would of course not be enough, but by the time he asks this
question, he should have experienced so many things with his senses that your
reply will be accepted by him as satisfactory [Lowenfeld, 7956;88-89].io
The following is a concrete account of how one mother made a start on
bringing her son to the realization that he was blind. Davey, now 4, had
been blind since birth:
We came out of the house, and spring was in the air. Things smelled sweet
and new, and the sky was bright with stars.
"Smell, Davey," Al [his father] said, drawing his breath in deep. "Doesn't it
smell sweet?"
"Um," said Davey, inhaling with gusto.
"Um," Mary Sue [sister] echoed, sniffling up her small nose with short brief
sniflfs.
I hugged her against me, and then I glanced up at the sky.
"Look, honey," I said. "Look, Mary Sue, up at the sky. See the stars."
Davey put up his hand. "I want to see the stars, too," he said.
I looked over at Al, and his face was blurred in the dark or maybe it was
my sudden tears that made it seem blurred. For a minute, my throat closed
over, and I knew a pain so sharp I thought I could not bear it. But then I
knew that this was my opportunity, the time I had been seeking for. So I put
Mary Sue in Al's arms, and I sat down on the steps beside Davey.
"Listen, honey," I said, and I turned his face toward me. Then I stopped, and
for a second, there were no words to say. But then the words came, and I said
them. "Davey, some people in this world can't see things with their eyes. Those
people are called blind people. They have to look at things with their fingers,
the way you do. Annabel [a blind social worker whom Davey knew and loved]
is like that, and you are, too."
"But couldn't I touch the stars?" said Davey, and there was, of course, no
10 From B. Lowenfeld. Our Blind Children, 1956. Courtesy of Charles C.
Thomas, Publisher, Sprinefield. Ill,
160 Physical Disability — A Psychological Approach
loss or sorrow in his voice. He had found that very beautiful things could be
seen with his fingers. He was only four years old, and so he did not miss color
or hght when he had shape and substance.
"No, honey," I said, and I did not want to cry, not any more. "No, some
things in this world are too far away to touch, ever, and the stars are hke that.
Those things you'll have to learn about by hearing of them. Understand?"
He nodded his head against my shoulder.
"Sure," he said. But, of course, he didn't. He probably never would, not
completely. But I had told him [Henderson, 795-^:1 12-1 13]. "
In this brief scene, several important ideas were introduced: the mean-
ing of blindness, Davey is blind, other people are blind too, blindness
entails certain restrictions (disabling aspects) and thus certain aspects
of life must be met in a different way (coping aspects). But these marks
of difference from others were brought out with a deep but simple feeling
of love and acceptance. One such scene may not be enough, for ideas
sometimes "sink in" slowly and may require repeated exposures for the
self-picture to be positively imprinted with full values that are able to
withstand assault.
In Raymond's case, however, a comparable scene apparently never took
place (Goldman, 1947). That he was different in some ways from other
children and would continue to be different was never mentioned. He was
praised for cooperating with the exercises and striving to crawl, etc., but
no special reference evidently was made to the shortcomings of his legs.
"They [his parents] entered into a fine conspiracy of cheerfulness, hope,
and courage, and throughout my childhood I was treated the same as my
brother and sisters" (p. 6). Raymond came to identify being loved with
being perfect as epitomized in the frequent scenes in which his parents,
nurse, and older sister "kissed me [being loved] and said lovely things
about me [being perfect] to each other while I listened from my seat in
childhood's heaven" (p. 11). Whatever subconscious awareness he had of
his own physical inadequacies was counterbalanced by an active fantasy
life in which he envisioned "a personal vigor and physical strength that
were Gargantuan. I dashed about the city streets, uprooting tall trees with
my bare hands. Or, more constructively, I ran like the wind on my own
fleet legs to spread the alarm of fire to every inhabitant" (p. 3).
Through the techniques described in Chapter 11 Raymond could also
have been prepared for the prejudices he would inevitably experience.
Storytelling, role playing, and discussion would have all been in order.
Not only would these have equipped him with certain social skills but, in
exposing him to the negative aspects of his disability, the necessary
11 Lois T. Henderson, The Opening Doors. New York. The John Day Com-
pany, 1954. By permission.
Development of fhe Self-Concepf 161'
reorganization of the self-concept would have been taking place in a
protective atmosphere. The companionship of other children with dis-
abilities in an accepting atmosphere of the home or nursery school would
have provided the opportunity for "the mental and emotional experience
of recognizing another human being as possessing simultaneously a
recognizable disability and a lovable self" (Garrett, 1955:441). This, as in
group counseling, favors the assimilation of the negative aspects of dis-
ability within a self -concept that could remain positive.
Being brought face to face for the first time with one's shortcomings
in a hostile and rejecting environment can be such a devastating experi-
ence that precautions must be taken to avoid this, particularly in child-
hood. It makes all the difference in the world if painful facts about the
self are first realized in a friendly and accepting atmosphere. In the former
case there is a cementing between the self-core and the negative fact,
whereas in the latter case there is a separation. (A particularly favorable
relationship for the accomplishment of this separation exists in therapy,
where the patient is unconditionally accepted.) Therefore, if by the age of
8 Raymond already had come to some grips with some of the displeasing
aspects of his physique in his own home where he was loved and accepted,
his self-concept would have had a far greater inner strength to stand up
against the barbs being thrust at him by the boys who were so unfriendly
on that first day at school. He still would have fought and cried, but the
strong core of his self-esteem would not have been shattered.
Chapter
Self-Concept and the Perception of
Interpersonal Relations
7
"BELIEVING IS SEEING"— ILLUSTRATED
Harold Russell {1949), the soldier who lost his hands, reacted
differently in the following two situations involving discussion of his
injury:
Scene i. In a bar during Russell's
first pass to town from the hospital.
We had just ordered our first round
when I noticed someone at the bar
staring right at me. I tried to ignore
him, but he wouldn't stay ignored. I
could feel him watching me. Presently
he came over. He was a blubbery
hunk of fat and had three or four
chins dripping down his vest. He
pulled up a chair and made himself
at home. Apparently he believed that
everyone loves a fat man. He ordered
a round of drinks for all hands.
"Thanks, mister," I said, "I still got
one."
"So you'll have another! On me,
Joe! Always good to have reserves on
hand. That's how we win battles." He
winked and looked around us, trying
to milk a laugh. None of us made a
sound. He squirmed momentarily,
then shifted to the subject that he was
really interested in. "Tell me, sergeant,
how did — "
" — you lose your hands?" One of
my buddies finished the question for
him.
Scene ii. Sometime later in a res-
taurant shortly before Russell wai
ready for discharge from the hospital.
The night we were at Ruby Foo's
[restaurant] I was wielding my chop-
sticks at a great rate — I'd learned how
in Boston's Chinatown — when a man
came over from another table.
"I was noticing," he said, "how well
you managed those things."
"These?" I held up the chopsticks.
"No — I — er — mean those — " He
swallowed hard and nodded at the
hooks. "Well — those — "
"Oh! You mean, my hooks?"
He sighed with relief. It was obvi-
ous he had been embarrassed to call
them by their right name.
"I couldn't help noticing how skil-
ful you are with them," he said. "You
can just about do everything with
them, can't you, sergeant?"
"Everything," I said, grinning, "ex-
cept pick up a dinner check."
That drew a laugh. I could see the
man relax at once. That made me
relax, too [p. 151].^
162
Self-Concept and Interpersonal Relations 163
"Why, how did you know what I
was gonna ask?"
"Maybe you'd Hke to tell me how
you lost your teeth?" I said.
"Just tryin' to be sociable — " he
said, backing away nervously, beads
of sweat glistening all over his fat
face, his tiny opossum's eyes darting
from one to another. "No offense in-
in-intended — I — I — I'm sure — no of-
fense— "
"Scram!"
"Before I give you these!" I added,
shaking my hooks at him [pp. 122-
123].
What was the difference that made a difference to Russell, so that in
the first incident he felt he had been insulted, whereas in the second he
actually had enjoyed the situation? Was the difference in the other person,
in the one case blustering and pitying, and in the second more reserved
and respectful? Perhaps to some extent, but there is evidence that in the
interim between the two scenes Russell himself had undergone change, a
change that drastically affected his perception of the intentions of others.
Russell, after many experiences in which he felt self-conscious and like a
freak on exhibition, in which he froze up in regard to discussion of his
hooks, began to arrive at important new understandings. He notes:
. . . Gradually, it began to seep through my skuU that folks were not just
being morbid and inquisitive, but that they were genuinely interested in me.
When a stranger offered to buy me a drink it wasn't cheap charity, but a kind
of acknowledgment of a debt he felt he owed to all who had served. I began
to notice, too, that I wasn't the only GI who was being offered free drinks.
Almost every man in uniform, whether disabled or not, was getting his share
of them [p. 150].
Moreover, this changed perception paralleled significant transformations
within Russell's system of values, heralding progressive acceptance of his
disability. The following introspections point to the kinds of reevaluations
occurring in his outlook on life:
Containing disability effects (see pp. 118-128) :
Sooner or later, I had to face the problem of how I was going to earn a
living. After giving it a great deal of thought, I discovered a startling fact: my
1 Harold Russell with Victor Rosen, Victory in My Hands, copyright 1949.
Used by permission of the publishers, Farrar, Straus and Cudahy, Inc.
164 Physical Disability — A Psychological Approach
hands had not been as important as I thought. There were lots of occupations
where I wouldn't be too seriously handicapped [Italics ours] [p. 147].
Subordinating physique (see pp. 115-117) :
. . . That was the great lesson of his [Frankhn D. Roosevelt's] magnificent
fight. That was the innermost secret of his triumph. He had overcome not only
his physical handicap but his spiritual one, as well. He had accepted his dis-
ability. For what he had missed he had gained something immeasurably more
valuable. He was the master of himself and his destiny [p. 142].
Transformation to asset value (see pp. 118-133) :
... I would have to realize that I had nothing to be ashamed of. ... I
began to see that it's not what you've lost that counts, but what you have left
[pp. 142-143].
As long as Russell damned his disability with the epithets degrading,
devastating, and disgusting — any social interaction, real or imagined,
which so much as touched upon his disability would signal personal threat.
At the time of the first scene, this was Russell's phase in the process of
accepting his disability. When, however, the meaning of his disability
began to change, as indicated by the value transformations indicated
above, social interactions correspondingly appeared different to him.
That social perception is a function, among other things, of self-percep-
tion is strikingly shown in Goldman's reminiscences in which the same
situation was first interpreted in one way and then antithetically, only
because his self -concept had undergone fundamental change. In the first
example, Raymond Goldman (1947), crippled from polio and now 8
years old, is meditating about the feelings of other persons toward him.
Until recently, he had known little of shame. His family had been loving,
and his efforts to do things had been greeted by praise and encouragement.
But now he had become fully aware of the fact that he was not like other
children. During his first day at school he had been taunted and ridiculed
(see pp. 145-146 for incident) : he "learned" that he was "a pariah
among the strong and straight." What had before seemed like kindness
and admiration was now defiled by pity and scorn:
... I knew now why strange women on the street smiled at me when Chris-
tina [his sister] wheeled me along in my gocart, sometimes stopping to chuck
me under the chin or pat my head. It was because they pitied me, not because
they admired me. I knew now why children along the way stopped their play
and stared at me. It was not because they liked me and wished they could play
Self-Concept and Interpersonal Relations 165
with me, but because they were disgusted by the sight of a boy my age riding
in a gocart [p. 39]. 2
The second example, ten years later, reveals the reverse direction in which
a previously negatively interpreted relationship now is viewed positively.
This change, as in the case of Harold Russell, reflected basic adjustive
value transformations during Goldman's struggle with acceptance of dis-
ability (see pp. 27-35 for an analysis of this struggle) :
, . . When I had played ball with the boys, wearing heavy braces, passers-by
had often stopped to watch me. I had thought they were pitying me and I had
hated them for it. Now I knew that I should have been grateful to them for
that meed of recognition of my striving [p. 94].
The problem of self-concept and the perception of interpersonal rela-
tions is not, of course, limited to the way in which a person views his
disability. It has the widest application. For example, Maslow {1939), in
his studies of personality and social behavior, has reported that women
low in dominance "can not 'take' compliments in spite of . . . their need
and hunger for them. This is because they are apt at once to discount the
compliment as untrue and seek suspiciously for other motives. Often, for
example, they may think the compliment is making fun of them, holding
them up to ridicule, or else trying to get something out of them" (p. 21).
As Santayana is reported to have said, "The empiricist . . . thinks he
believes only what he sees, but he is much better at believing than at
seeing" (Korzybski, 1951:116).
INTERPRETATION OF SOCIAL RELATIONSHIPS
IN THE FRAMEWORK OF PERCEPTION
The problem concerning the relationship between feelings about the
self and the interpretation of the behavior of other people toward oneself
is part of the larger problem of variables within and without the person
that influence perception (Witkin et ah, 1954; Blake and Ramsey, 1951;
Symposium, 1949). Experiments on the role of expectations or mental
set help to clarify the problem.
In Kelley's (1950) experiment, subjects were asked to rate an unknown
instructor, after he had led the class in a 20-minute discussion, on such
traits as conscientiousness, popularity, intelligence, humor, etc. Some of
the students had been informed that the instructor was reputed to be
2 Selection from Raymond Goldman, Even the Night, copyright 1947, The
Macmillan Company, is used with the permission of the publisher.
166 Physical Disability — A Psychological Approach
"rather cold" and the other students that he was "very warm." One of the
main results was that the warm-cold variable produced large dtflferences in
the evaluation of the behavior of the instructor. Students given the
"warm" prior information consistently rated the stimulus person more
favorably than did those given the "cold" prior information. Thus, the
information as to whether the instructor was a warm or cold person
geared the subject to select and highlight those aspects of his behavior
that were in harmony with that concept.
Of course, the conditions within the person do not always primarily
determine the interpretation of another's behavior to the exclusion of
objective events. Clearly, the conditions "out there" affect one's percep-
tions. Kelley's experiment, in addition to demonstrating the potency of
expectations for evaluations, also demonstrated the influence of the in-
structor's behavior itself. It happened that two instructors who were very
different in personality and behavior served as the stimulus person in the
several groups of subjects used. There were marked differences in the
degree to which the warm-cold variable was able to produce differences
for the two instructors. For example, even though the "warm" observers
rated instructor B more favorably on the popularity and humor scales
than did the "cold" observers, he was still rated as "unpopular" and
"humorless," which evaluations agreed with his typical classroom be-
havior.
There is further experimental evidence to indicate, however, that what
may objectively be determined as solid and irrefutable evidence may still
be denied or distorted when the subject has a strong expectancy of con-
trary fact. An experiment by Bruner and Postman (1949) is particularly
relevant. Subjects were presented with playing cards, some of which had
suit and color reversed (e.g., black hearts and red spades), for brief
exposure periods. Initially, almost all the subjects saw nothing unusual
about the trick cards. Congruence between color and suit was effected by
misperceiving either the suit or the color at exposure levels well above
the threshold for such recognition. Thus, a red six of spades was reported
with considerable assurance as being either the red six of hearts or the
black six of spades. An equally significant fact, however, is that with
increase of exposure time the percentage of correct recognition of the
bizarre cards progressively increased. That is, expectations held greatest
sway under conditions of ambiguous stimulus information and became
less influential as the stimulus input became more reliable. The complexity
of the interdependence between stimulus and person variables for percep-
tion is seen in the following hypothesis offered by Krech and Crutchfield
(1948:95-98) : If the stimulus differs but slightly from the expectation, the
perception will tend to be assimilated to the expectations; however, if the
difference between the stimulus and expectation is too great, the percep-
Self-Concept and Interpersonal Relations 167
tion will occur by contrast to the expectation and will be distorted in the
opposite direction.
It is to be noted that on the environmental side the degree of ambiguity
or unreliability of the stimulus information can vary: the more clear-cut
and reliable the input information, the more effective it will be in structur-
ing the percept. The degree of ambiguity has been controlled in the labora-
tory by the use of such experimental techniques as dimly Uluminated
pictures or words, tachistoscopic (briefly exposed) materials, ambiguous
drawings, etc. As for the person, the strength of expectations can vary:
the stronger the expectation for certain events, the greater its potency in
structuring the percept. Expectancy strength has been controlled in the
laboratory by information, past experience, and other kinds of set.
In summary, it can be stated that as the features of the environmental
stimuli become more ambiguous, the subject's perceptions increasingly
adhere to his own expectations. The expectations become an organizing
principle according to which facts are made to fit. It is especially im-
portant to understand the factors that influence expectations concerning
the behavior of others toward oneself since such behavior is often per-
ceived according to one's expectations.
THE ROLE OF SELF-CONCEPT IN EXPECTATIONS
The opening section of this chapter illustrated the significance of self-
perception for social perception. The expectations of Russell and Gold-
man in the situations where the behavior of others was positively
evaluated clearly differed from those in the situations evoking negative
evaluation. In turn these expectations depended upon how they felt about
themselves, their self-concept. When they viewed their disability with
shame and derision, they could expect only that others felt likewise; this
is what they saw in the questioning, the staring, the help of others. When
they were able to accept their disability more fully, it became sensible that
others could view them as self-respecting, worth-while, and even admira-
ble. Instead of ignoring this expectation as a possibility, they could then
entertain it, and once entertaining it, they could see the corresponding
positive attitudes in the behavior of others.
There are several reasons why the self-concept plays a role, often
decisively, in the interpretation of social relationships. An important one
is that it is a necessary (though not sufficient) part of the total situation.
The subject sees that the other person is reacting to him and therefore he
must take himself into account as an object of stimulation. The kind of
"account" he takes of himself is usually drawn from his self-concept, for
in most social situations there are few other clues as potent in defining the
168 Physical Disability — A Psychological Approach
kind of person one is. He has a full and deep experience of himself and
sees himself in a more or less incisive way, even though upon further
introspection he may well become ambivalent and confused. In a particu-
lar situation he feels that he is right or wrong or at least in between, that
he is competent or not or at least in between, that he is handsome or not
or at least in between. He does not have as direct access to the other
person's regard of him.
It might seem that all that is necessary when one is interested in the
behavior and intentions of another person is to attend to his actual be-
havior, inasmuch as that is the direct expression of what he is feeling.
That this is not always the case is indicated by sound research. The well-
known problem and experiments on the interpretation of human emotions
from photographs are particularly relevant (Woodworth and Marquis,
1947:354—360). Though the findings indicate that the emotion portrayed
is not often mistaken for its opposite, they also show that a knowledge of
circumstances leading up to the emotion may be an important condition
of emotional recognition. To take Asch's example: "The sight of the
relaxed face of a man who is watering his garden has one physiognomic
quality; the same expression has a wholly different value if the man has
just committed a murder" (7952.194). In the case of an emotion directed
toward me, my characteristics as an "object" of stimulation to the other
person, and usually available to me via the self-concept, are a highly
relevant part of the surrounding conditions.
A second set of factors leading to the preeminent position of the self-
image in the interpretation of social interactions is that the clues reflecting
the attitudes of the other person are often ambiguous and difficult to pin
down. There are several reasons for this. First, such attitudes as respect,
warmth, annoyance, disapproval, which the subject senses or tries to sense
because of their vital personal relevance, are expressed in multifarious
ways. The affection of one person may spill over effusively, whereas in
another it may receive satisfying expression in comparatively restrained
ways. In addition, the same overt behavior may reveal different underlying
emotions, particularly when the behavior in question is a relatively small
unit so that further elaboration in terms of causes, consequences, and
implications are cut off from view. For example, the same obstreperous
behavior of a child may be judged to be an expression of fatigue, stub-
bornness, anger, or the struggle for independence. Furthermore, attitudes
toward another are complex and often conflicting. It is possible for a
mother, for example, to become irritated with the demanding behavior
of her child but at the same time to love and to cherish him. Similarly,
the attitudes toward a person with a disability not infrequently reflect
both positive and negative feelings, either simultaneously or at least in
rapid succession. For example, the person with a disability may be
Self-Concept and Interpersonal Relations 169
admired for his success at meeting his situation and pitied because he is
still a cripple. Psychoanalytic theory and clinical experience leave no
doubt that ambivalence toward others occurs frequently, perhaps even
typically, and is a consequence of the multifaceted aspects of our relation-
ships to other persons.
Sometimes, however, a person may have independent information as to
how another person feels about him. The information may be hearsay; it
may be based on repeated and unequivocal past experience with the other
person. In certain circumstances he may wish and be able to set aside his
own self-image and substitute the picture of himself as drawn from the
perspective of the other person.
Nonetheless, because of the particular relevancy of the self-concept in
social interactions and of the ambiguity of the environmental stimuli (i.e.,
the behavior of the other person) , the self -concept acquires an importance
that surpasses its actual effectiveness in gauging correctly the attitudes of
others. The person comes to expect certain attitudes and feelings toward
himself, expectations rooted in his self -concept.
EXPECTANCY STRENGTH
The strength of expectations largely determines the degree to which
they affect perception. This holds true for expectations in general, whatever
their source, and not only those arising primarily from the self-image.
Because of our special concern with problems of acceptance of disability
and because of the special role of the self -concept in social expectations,
we shall largely restrict our examples to expectations anchored to the
self -concept.
The work of Bruner (1951) provides a soundly considered and well-
integrated conception of some of the important determinants of the
strength of an expectation. His work forms the basis of our application to
disability-connected problems.
Bruner's fundamental proposition is that perceiving begins in an
organism tuned to select certain features of his environment by an ex-
pectancy or hypothesis or set. These several terms are used to give the
flavor of the highly generalized state of readiness to perceive in a given
way. The assumption is that "we are always to some extent prepared for
seeing, hearing, smelling, tasting some particular thing or class of things"
(p. 124). Whether any organism is ever completely "untuned" need not
concern us here. Our concern is more with those conditions that affect the
power of the "tuning" to channel perception into meaning and evaluation,
for in the process of acceptance of a disability it is the tuning that largely
determines the key to understanding.
170 Physical Disability — A Psychological Approach
Bruner offers three propositions concerning the concept of expectancy
strength: The stronger an expectation, (1) The greater its likelihood of
arousal in a given situation; (2) The less the amount of appropriate in-
formation necessary to confirm it, and (3) The more the amount of
inappropriate or contradictory information necessary to refute it.
The expectations with which a person enters a situation, therefore, not
only put the spotlight on what he will see but also, as a function of their
strength, delimit the degree of incompatibility with objective fact that can
be tolerated. Thus, when a person has a strong feeling of shame and
inferiority, the more often will his experiences tend to bear out his expec-
tations that he is indeed to be pitied and cast aside. He will see confirma-
tion in even the most modest evidence, and disruption of the expectation
would require considerable proof to the contrary. Expectancy strength
can now be seen as of central importance in determining whether accept-
ance of a disability will proceed as a matter of course or whether it will
meet difficulties along the way as the struggle is tested in life's experiences.
What, then, are some of the conditions that strengthen or weaken an
expectation? Bruner (1951) proposes five such determinants. In his
exposition he has carefully attempted to tie them to experimental findings.
1. Frequency of past confirmation. The more frequently an expecta-
tion has been confirmed in the past, the greater will be its strength: It will
be more readily arousable, require less environmental information to
confirm it, and will, conversely, require more contradictory evidence to
negate it than would be required for a less frequently confirmed expecta-
tion.
The significance of past confirmation for expectancy strength has been
demonstrated in a variety of experiments. For example, in the playing-
card experiment described above, the fact that it took a far longer ex-
posure time to recognize the cards that had suit and color reversed than
those that did not is explained by a strong expectation for normal suit and
color combinations built up through many past confirmations (Bruner
and Postman, 1949).
Laboratory experiments have also shown, however, that frequency of
confirmation does not operate in a simple way to increase strength by
uniform increments. Sometimes a single contrary experience can markedly
weaken or even wipe out an expectation that previously had many con-
firmations. Again we draw upon the playing-card experiment. Once the
subject "caught on" that suit and color might be reversed, an expectation
for incongruous as well as normal cards was established that served to
weaken measurably the initial sole expectation. For a clinical example, the
life history of Raymond Goldman {1947) may be recalled. During the
first four years of his disability, he had many, many experiences in which
Self-Concept and Interpersonal Relations 171
he was respected, lauded, encouraged, and loved. His expectation that
others felt positively toward him was hardly if at all contaminated by
doubt until his first day at school, when in one "fell swoop" the violence
done to his self-concept correspondingly affected his expectation (see pp.
145-146 for incident).
The conclusion is warranted that expectancy strength is a function of
frequency of past confirmation in which the confirming or infirming power
of a single experience varies enormously, depending upon what it does to
the cognitive outlook of the person. This does not contradict the common-
sense feeling that frequent exposure to devaluating experiences in the
important areas of life, such as home, school, and job, provides fuel for
the smoldering conviction that one is an object of pity. It simply forces
recognition of a second common-sense feeling — namely, that frequency as
such is not everything and that one experience can be more effective or
destructive than another. It would be unfortunate if frequency alone
mattered, for then therapy would have the impossible task of altering the
attitudes and percepts of an individual that had been built up over a life-
time of experience.
2. Monopoly. The smaller the number of alternative expectations held
by the person concerning his environment, the greater their strength will
be.
Bruner (1951) describes the relevant experimental evidence and points
out that though it is rather scanty, it is unambiguous (p. 129). He
mentions the study in which less exposure was required for the recogni-
tion of words having to do with food when the subjects were given the
instruction to find such words than when they were told to find food
words or color words (Postman and Bruner, 1949).
Applying this determinant of expectancy strength to disability problems,
we may compare the person whose expectation that others will look
down upon him has full reign with the person in whom this expectation
is shared with such others as "My disability may not matter to them";
"they may not even notice me"; "they may admire my accomplishments."
In the former case, the expectation of devaluation will be confirmed by
less evidence than in the second case, and also it will be more tenaciously
retained in the face of contradictory information. This suggests that expos-
ing the person to alternative and more positive attitudes toward disability
facilitates psychological rehabilitation.
3. Supporting context.^ A particular expectation is embedded in a
larger system of supporting hypotheses and beliefs. The larger or more
integrated the number of supporting hypotheses, the stronger will be the
expectation. Bruner cites one experiment in support of this — namely,
3 Bruner's term for this is "cognitive consequences."
172 Physical Disability — A Psychological Approach
that a reversed letter is less easily detected when it is embedded in a
meaningful word than in a nonsense word. In the former case, the sup-
porting context of a meaningful word strengthens the incorrect expecta-
tion that all letters are facing correctly (p. 129).
This determinant points up a crucial step in adjustment to disability —
namely, that the overcoming of shame and inferiority may be facilitated
when supporting hypotheses are eliminated. Examples of hypotheses sup-
porting disability as a sign of personal inferiority are:
1. My disability is a punishment.
2. It is important to conform, not to be different.
3. Most people are physically normal.
4. Normal physique is one of the most important values.
5. Physique is important for personal evaluation.
6. A deformed body leads to a deformed mind.
7. No one will marry me.
8. I will be a burden on my family.
9. My deformity is revolting.
10. I am less valuable because I can't get around (or see, or hear) as others
can.
Which of these supporting beliefs can be eliminated is a challenging
issue to consider. Some of them may be discarded or at least weakened
through factual and scientific knowledge: e.g., "most people are physically
normal"; "a deformed body leads to a deformed mind." Others require
basic changes in one's value system or outlook on life: e.g., "normal
physique is one of the most important values"; "it is important to con-
form, not to be different." Even the last hypothesis, that because of a dis-
ability one is less valuable than others or than one "would have been," a
hypothesis regarded as almost axiomatic by many, is challengeable. Pearl
Buck (1950) learned this through suffering for her helpless, retarded
child, and meeting that suffering:
So by this most sorrowful way I was compelled to tread, I learned respect
and reverence for every human mind. It was my child who taught me to under-
stand so clearly that all people are equal in their humanity and that all have
the same human rights. None is to be considered less, as a human being, than
any other, and each must be given his place and his safety in the world [pp.
51-52].4
Parents may find comfort, I say, in knowing that their [retarded] children
are not useless, but that their lives, limited as they are, are of great potential
* Reprinted by permission of Harold Ober Associates, Inc. Copyright, 1950,
by Pearl S. Buck.
Self-Concept and Interpersonal Relations 173
value to the human race. We leam as much from sorrow as from joy, as much
from illness as from health, from handicap as from advantage — and indeed
perhaps more [p. 57].
And because Pearl Buck challenged hypothesis 10 and others, she was
able to say to all parents of atypical children and to mean what she said:
Be proud of your child, accept him as he is and do not heed the words and
stares of those who know no better. This child has a meaning for you and for
all children. You will find a joy you cannot now suspect in fulfilling his life for
and with him. Lift up your head and go your appointed way [p. 59].
4. Motivational consequences. Expectations satisfy the needs of a
person in varying degrees. The more relevant the confirmation of an
expectation may be to the satisfaction of needs, the stronger the expecta-
tion will be: it will be more readily aroused, more easily confirmed, less
readily repudiated.
Bruner (1951) cites various lines of evidence substantiating the role
of motivational support in strengthening expectations and also calls atten-
tion to the complexities involved (p. 130).
With regard to disability problems, this proposition gives to what has
been called "secondary gains of disability" a theoretical position of signifi-
cance. A disability may serve many purposes. The person may wish to
insure continuing financial compensation that his disability provides; he
may welcome the dependency facilitated by his disability; his disability
may satisfy a masochistic need for punishment; it may afford him social
sanction for avoiding competitive striving, which he fears. All these are
motivational supports that will lead a person to cling to expectations con-
firming the disabling aspects of his disability. He will also resist such value
changes as containing disability effects and subordinating physique, for
example, for these bring out the abilities and positive strivings of the
person instead of the disabling aspects.
By the same analysis, the counterparts of these motivational supports
should strengthen those expectations in which the disability is minimized.
The man who has a strong need for independence, for example, will on
this account expect fewer limitations from his disability. He will also
require less convincing evidence that disability effects can be drastically
contained. The point is a simple one. When a disability is satisfying for
one reason or another, it becomes magnified through beliefs and expecta-
tions. When a disability runs counter to the important needs of the person,
its disabling aspects are correspondingly diminished through beliefs and
exnectations.
174 Physical Disability — A Psychological Approach
5. Shared Verification.^ An expectation may be strengthened by virtue
of its agreement with the expectations of other observers to whom the
perceiver may turn.
A pertinent experiment in support of this is that of Asch (1952: Chap.
16) on the modification of judgments by groups. Subjects were asked to
report verbally in small groups the relative lengths of lines that perceptu-
ally were clear-cut and stable. In the main experiment, all the subjects but
one had been instructed unanimously to oppose the critical subject by
reporting incorrect judgments at certain points, leaving the critical subject
a minority of one. In these circumstances, though the input information
was clear-cut, the critical subject of each group became generally insecure
and yielded to the incorrect majority in one third of his responses. When,
however, a partner was introduced who was to support the critical subject
by consistently giving the obviously correct responses, the majority effect
was markedly weakened. In only one eighth of their responses did the
critical subjects yield. The presence of a single confirming voice served
to strengthen the subject's conviction and enabled him to follow more
consistently and independently his own sensory information. Festinger
(1954) has developed a theory of social comparison processes based on
hypotheses that stress the importance of shared verification in supporting
one's judgments. One of the corollaries, for example, states that in the
absence of both a physical and social comparison, subjective evaluations
of opinions and abilities are unstable.
Applying the factor of shared verification to disability problems, we
may conclude that if a person is surrounded by the judgment that a dis-
ability is a horrible calamity which denies all the important satisfactions
in life, then it will be more difficult to change this expectation in the
person himself than if his social verifiers supported a more moderate view.
Having examined the self-concept and expectations as influencing the
perception of social relations, we may wonder how one ever manages to
be on the right track, to perceive the intentions of others correctly, to
have harmony in social relations. Ichheiser (1949) has written a percep-
tive analysis of sources of misunderstandings in human relations with
emphasis on cognitive factors. We wish now to discuss how understand-
ings can and do take place even though in many social situations we see
things in some measure as we are rather than purely as they are.
EXPECTATIONS AND SOCIAL UNDERSTANDING
There are several factors that lead the person, p, and the other person,
o, to see things sufficiently alike to allow for mutual understanding. First,
5 Bnmer's term for this is "social consequences."
Self-Concept and Interpersonal Relations 175
as we have noted previously, there is the role played by reality itself.
Under clear-cut environmental conditions, expectations play a less
dominant role. In some social situations the behavior of another has such
a firm and indisputable structure of its own that it forces its own meaning
on the interaction in spite of the fact that the self-concept and consequent
expectations may be at variance with it. This may be more apt to occur
after several exposures to the other's behavior just because expectations
do play a directive role. The following example is illustrative:
Mary, a young woman who required bed rest for several days during an
illness, rejected the genuine attempts of her friends to help, as in meal
preparation, caring for the children, providing transportation to the
doctor. Each offer was resisted until finally Mary said, "Everyone's been
so nice to me. It makes me feel that they like me." Mary, who for a long
while had regarded herself as unworthy, at first could only interpret the
help as mere formality. It was only when the offers were made repeatedly
and effected over her protestations that she could accept the help for what
it was, an expression of real friendship. The property of the behavior of
those close to her finally impressed its own character on her perception.
There is another factor, also mentioned earlier, that enables people to
understand each other. There are times when the person structures himself
as an object of stimulation to others not in terms of his self-concept but on
the basis of independent clues, such as information. Thus, when a thief is
sure that his friend knows nothing of his irregularities, he may take not
his self-image but the honest version of himself as the basis for interpret-
ing the social interaction. Likewise, when a person with a disability knows
that the employer has an exaggerated notion of his limitations, he may
interpret his lack of promotion accordingly rather than in terms of any
aspects of his own self-concept.
Moreover, satisfactory interpersonal relationships need not require
identity of perception between the person himself, p, and the other person
o. In many situations, p's picture of himself as an object of stimulation
may sufficiently match o's picture of p to permit harmonious interpreta-
tions. For example, o may agree to some extent with p's notions as to p's
capability. It is also possible for p up to a certain point to misinterpret o
and still manage well together. Suppose p senses an annoyance in o that
he mistakenly attributes to fatigue. Although o may truly be annoyed,
the source of the annoyance may be entirely different — displeasure with
the task at hand, for example. Yet both may be able to accept the under-
cover friction without delving further.
Finally, a social interaction is a process that unfolds in the give and
take between the participating members. This means that the reality — i.e.,
what actually occurs — is not charted independently of the person's wishes,
fears, and expectations but to some extent is actually shaped by them. In
176 Physical Disability — A Psychological Approach
this way not only the reality as perceived but the reality as is may be made
to fit the person's expectations and self -concept. When Goldman (1947)
became aware of this he became overwhelmed with the implications :
I've discovered something else: the gym teacher was embarrassed when he
began to talk to me today. It was almost as if he felt the shame that he ex-
pected me to feel. But when he saw that I was not ashamed, his embarrassment
disappeared. Is that a manifestation of a kind of power that human beings hold
over each other? His attitude was in my control, it was /, not he, who deter-
mined what that attitude toward me should be. What kind of power is that?
How far can one use it? What is its source? [pp. 94—95].
Russell (1949) also began to realize that "the only way I could expect
to feel at ease with them [people] was if they felt at ease with me, and the
only way for them to feel that way was for me to be at ease with myself"
(p. 150). And once feeling at ease, he was able to establish social tech-
niques that put others at ease. Let us compare the following two situations
involving his hooks, the first when he was beset with embarrassment and
shame, the second when he felt comfortable about his hooks and thought
of them as "working hands."
The scene is Russell's first homecoming since his injury. He has just
deplaned:
When I finally got off I carried my bag in one hook and hid the other in my
pocket. I hoped they [those meeting him] wouldn't notice the one with the bag
right away. I tried to keep it out of sight, but the bag kept bumping against
my legs.
Rita [his sweetheart] spotted me first. She shouted and waved at me. Then
mother and Fred [a sailor friend] began doing the same. My first impulse was
to wave back at them. Then I realized how grotesque that would be. I kept
the hook in my pocket. It was only a hundred yards to where they were stand-
ing, but it seemed like I was on one of those twenty-five-mile marches. And with
every step I became more uncertain, more jittery, more scared. I wanted to go
straight back to the hospital.
Mother was the first to reach me. She folded me in her arms. "Darling! It's
wonderful to have you back!"
I kissed her. I started to put my arms around her. I caught myself just in
time.
She pushed me away from her and looked me over. "My, but you look
fine!" she said. I noticed she was careful to avoid where my hands had been.
Now Rita snuggled up to me. She gave me a long, tender kiss. I had a hard
job not taking her in my arms. I didn't dare. It might ruin everything. Imagine
having those hard, cold claws biting into your back! I could feel a shiver run
through her body as she pressed against me. I knew that as soon as she was
alone she'd let herself go, . . .
Self-Concept and Interpersonal Relations 177
All during the ride to Cambridge I could sense Rita and mother stealing
glances at the hooks. I felt like shaking them in their faces and shouting, "Here!
Take a good look at them! Fascinating, aren't they?"
I was sitting next to Fred. He was driving. All the time he kept looking down
at his hands guiltily as though he'd stolen something. That made me freeze up
even more. I couldn't keep my eyes off the wheel and he kept taking one hand
off it and sticking it in his pocket as if to hide it [pp. 129-131].
The second scene is after Russell had been discharged from the hospital.
He is thinking about different ways to put people at ease when they meet
him and his hooks for the first time:
First of all, I found it was extremely important to shove my hook out at a
person when I met him, just as if I were shaking hands with him. That had the
psychological effect of teUing him I wasn't worrying about my hooks, so why
should he? Or course, I knew that most people dreaded gripping that cold hunk
of steel the first time and I could hardly blame them, so I was always careful
to make that first handshake as casual, informal and friendly as possible.
Then there was the cigaret gag. That was invariably good for a laugh. When-
ever I'd walk into a restaurant, bar, or party I'd whip out a pack of butts, open
it ostentatiously, take one, light it and sit back puffing on it contentedly. That
almost always attracted attention. People would stare and I could almost hear
them saying, My! Isn't it wonderful what he can do with a pair of hooks?
Whenever anyone commented on this accomplishment I'd smile and say,
"There's one thing I never have to worry about. That's burning my fingers."
Corny, I know, but a sure icebreaker. . . .
It wasn't long before my plan paid off. I soon found people were taking me
and my hooks for granted. There would be that first shocked moment of con-
fusion and bewilderment. Then I'd throw my hook out, we'd shake, I'd pull one
of my gags and everybody would laugh. From then on everything would go
smoothly [pp. 166-167].
The difference between these two episodes has snowballing efTects. In
the first, Russell felt ashamed and expected others to be revolted and to
pity. He behaved accordingly, guiltily hiding his hooks, etc. And the
events that followed bore out his expectations. Others did feel embar-
rassed; others did shy away from his hooks. In the second, Russell had
made important headway in accepting his disability. He had already found
out that he could talk and think about his handicap without feeling self-
conscious or ashamed. Believing this, he could expect others to begin to
accept his hooks; it thus made sense for him to try to put others at ease.
And again the events that followed bore out his expectations. People
began to take his hooks for granted. In both episodes, the social reality
fulfilled Russell's expectations as much because Russell's behavior helped
178 Physical Disability — A Psychological Approach
form that reality as because he was set to interpret the behavior of others
in certain ways.
We should note once again that though expectations and self-regard
have such a directive role, they do not control all social reality. Russell,
no matter how good he felt about himself, perceived "that first shocked
moment of confusion and bewilderment," for example.
This discussion of expectations and social reality brings us to several
comments regarding adjustive relationships between a person with a dis-
ability and those around him. If, as there is a good reason to believe, the
so-called nondisabled hold both positive and negative attitudes toward
persons with disability, the positive attitudes will more readily be aroused
when the person has accepted his disability and believes that others can
accept it too.
It may happen that a well-adjusted person, in not looking for rejections,
may not see the rejection that actually exists. But this unawareness need
not be unfortunate. As Ichheiser {1949) has put it, it is highly probable
that certain illusions possess a positive function and value. It remains a
question whether all human relations would always operate more smoothly
or with greater satisfaction if they were altogether free of illusions. In not
seeing the rejection, the person may behave in ways more attuned to tne
positive chord in another and thus fan the "pilot light of the flame of
love." Should the rejection be so strong as eventually to come through,
the person's hurt would have a different quality from that which is heaped
upon self-rejection. It might be a hurt of sorrow that others are unjust or
do not understand him, or that certain activities and relationships are
denied him, but it would not be a hurt that, indeed, he himself is to be
rejected. At the end of his life story Russell {1949) states:
People like to feel sorry for me. I suppose that's only natural, too. Once it
used to bother me but it doesn't any more. It isn't important now what or how
anyone feels about my being without hands. The only thing that matters is that
I've learned to live without them and that I have mastered my handicap,
instead of letting it master me [pp. 278-279].
Expectations concerning the attitudes of others toward oneself are
crucial in the perception of those attitudes. To go one step further, the
self-concept is crucial in determining those expectations. The self-concept
is psychologically of such great importance that it can hardly be over-
stressed, though to be sure other factors, such as environmental condi-
tions and the actual attitudes of others, must not be understressed.
In the following chapter, the significance of the self-concept during the
adolescent period is discussed, especially as it relates to physique and
disability.
Chapter 0
The Adolescent with a Physical Disability
There are several reasons why the period of adolescence de-
serves special consideration. First, it is a period during which the self-
concept undergoes important changes. Secondly, physique plays an
especially prominent part in this new look at the self; it assumes a high
position on the status value gradient and a close connection with the self
(see pp. 148-153). Thirdly, the psychological situation of the adolescent
can be dynamically represented as overlapping both childhood and adult-
hood, an overlap similar to that involving minority groups (p. 16).
HEIGHTENED IMPORTANCE OF PHYSIQUE
DURING ADOLESCENCE
There are many reasons why physique is intimately bound up with
re-formation of the self-concept during adolescence.
1. The striking physical changes of adolescence bring about a change in
what others permit and expect of the young person. This may be illus-
trated by the expectations of parents and teachers for two pairs of girls,
each pair consisting of girls who differ greatly in physical maturity
(Barker, et ah, 7955:30-33). Though of the same chronological age (13-
14 years), one girl of each pair appeared to be a fully developed teenager,
dressing accordingly, whereas the other looked like a child of 10 or so.
The parents and teachers of each girl were asked to judge which of a list
of activities (e.g., buy dress by self) they considered proper for the girl.
The physically more mature girl of each pair was judged to be mature
enough for adultlike activities more frequently than the physically less
mature girl even though each pair of girls was in the same grade, of the
same mental age, and came from the same socioeconomic background.
2. The young person looks at his physique in the new light of sex
appropriateness. Not only do the more purely biological urges contribute
to this awareness, but the values of society also bring tremendous pressure
on the young person to examine himself in terms of the criteria of his sex
role. Particularly during adolescence, these criteria follow rigid standards
179
180 Physical Disability — A Psychological Approach
as to what the feminine and masculine model should be. Marriage and
children are deeply ingrained values of society and, in fact, are often
necessary passports to full adult status. Small wonder, then, that the
adolescent as he grows into adulthood keeps testing himself as to whether
he can make the grade. His final score requires not one look at the self
but many, as each experience with members of the opposite sex is assessed.
The status value of physique assumes tremendous potency because of its
identification with rigid and idealized notions of what is admissible to
each sex. In one study, two thirds of the adolescent boys who were dis-
satisfied with their physiques were troubled with aspects that the authors
describe as "sexually inappropriate," e.g., development around the nipple
area, size of genitals, scanty pubic hair, fat hips, and facial blemishes
(Stolz and Stolz, 1944).
In the following personal account, the impact of sex appropriateness
on the adolescent's evaluation of a physical trait and of himself as a person
is dramatically clear. What had been a disturbing fact became a source of
pride at the very moment that its significance changed from sexually
inappropriate to ideally befitting the sex-role aspirations of the subject:
All through my grade school years, I was the tallest in the class, and, as a
matter of fact, was rather proud of it. However, the summer before I entered
Junior High School at the age of thirteen, I grew to just an inch below my
present five-feet-eight. I towered above every girl and boy in our class; and it
seemed to me that I was the tallest girl in the world. None of my family's
comforting words made it easier for me to walk across the room at school. In
high school, two girls taller than I entered the class. But they weren't in our
crowd, so I continued to feel like a giraffe when I went out with the girls. I
suppose the fact that several of the boys grew to six-footers helped dispel that
shrinking feeling. But the crowning touch came in the spring of my junior year.
The school paper published a list of characteristics of a composite "Ideal Girl."
Lo and behold, my name was listed after "Ideal Height." I haven't felt too
tall since [Sherif and Cantril, 1947:11^].^
It has been concluded that once the boy feels accepted as a man and the
girl as a woman, they "become more stable and predictable. Teachers and
parents say they have 'settled down'" (Sherif and Cantril, 1947:231).
Such acceptance is often not the smooth consequence of natural develop-
ment we would like it to be. Doubts in the area of sexual adequacy are
kept actively astir by the rigid standards of what constitutes appropriate
physique, by the preconceived notions as to what the sexual relationship
ought to be, by the necessity for postponing marriage long after sexual
1 Reprinted with permission from M. Sherif and H. Cantril, The Psychology
of Ego Involvements, copyright 1947, John Wiley & Sons, Inc.
The Adolescent with a Physical Disability 181
maturity, and by the fact that any real or imagined physical deviation
readily becomes the scapegoat for all personal difficulties.
3. Physique affects the new self -look during adolescence in yet another
way. Unlike the younger child, the adolescent tends to regard his physique
as the final edition of himself. He certainly is aware of physical decline
with age, but that indefinite future is unrelated to his present state. He
now is grown up, in the prime of life, and his physical equipment is the
best that he can hope for. On the other hand, the child, realizing that he is
growing and therefore changing, can more readily discount an unpleasant
body image as a temporary imposition and look toward a more suitable
physique that the benevolent future will bestow. The child's perceptions
are, in fact, more amenable to the influence of wishes on the "level of
irreahty" than are the adult's (Lewin, 1936:104). Carlson (1941), who
was born with severe spasticity, recalls that as a child "I formed a pas-
sionate faith that a . . . miracle would be achieved when I grew up : that
halting feet, shaking head, writhing arms and legs, and troubled speech
would all be healed" (p. 19). But as an adolescent "... I became so
self-conscious about my handicaps. . . . For the first time the realization
that I was different from other people sank home" (p. 22) .^ The im-
mutability of physique has the important effect of placing physique close
to the self on the self-connection gradient, thereby giving to it a command-
ing role in the process of reevaluation of the self during adolescence.
It has been pointed out that, through the convenient mechanism of dis-
placement, somatic defects can be made the scapegoat of all adjustive
difficulties and the causes of all anxiety feelings regardless of their original
source. Because physique becomes a prominent and important charac-
teristic during adolescence, it may very well fulfill this scapegoat function
with surprising uniformity.
Although physique carries a particularly heavy emotional loading dur-
ing adolescence, it is not correct to conclude that any single physical
deviation will invariably or even probably produce distress. "The psycho-
logical consequences of deviation will depend on 'social and individual
attitudes toward non-conformity,' the strength of intrinsic attitudes of
self-acceptance and the possession of compensatory assets" (Ausubel,
1952:102),^ as well as the meaning of that particular deviation for the
individual. To give a concrete example of the individuality of reaction to
deviation, we again refer to the study of adolescents by Stolz and Stolz.
Of the seven boys who were concerned about their shortness, four were
2 By permission from E. R. Carlson, Born That Way, copyright 1941, The
John Day Company, publisher.
3 D. P. Ausubel, Ego Development and the Personality Disorders, 1952. By
permission of Grune and Stratton, publishers.
182 Physical Disability — A Psychological Approach
actually among the shortest 15 percent of the 92 boys all through the
adolescent period. But there were five other boys in the same short group
who gave no evidence of being disturbed about it. And two of the seven
were as tall as 20 percent of the total group (Stolz and Stolz, 1944:81).
This is one important reason why studies that correlate variations in
physique such as size, strength, and attractiveness with adjustment
measures almost invariably yield but slight, if any, relationship (Barker
et al., 1953: Chap II). ". . . the reader should remember that just what
the meaning of variation in somatic conditions will be to any boy or any
girl can only be determined by a study of the individual" (Stolz and Stolz,
1944:80).
OVERLAPPING SITUATIONS IN ADOLESCENCE
"In American society there is a child culture and an adult culture.
There are ways and goals of behaving that are accepted as appropriate for
children, and quite different ways and goals of behaving that are con-
sidered appropriate for adults. Correct ways for children to eat, sleep,
dress, talk, and work, for example, differ in many respects from the ways
that are correct for adults" (Barker et al., 1953:28). During the transi-
tional period of adolescence the individual may be described as being in
an overlapping situation, being a child on the one hand and an adult on
the other.*
Uneven physical maturity, conflict between giving up the comforts of
dependency and attaining adult status with its widening horizons, plus
ambivalent adult attitudes toward the child's ambiguous status — these
factors and others contribute to the stress of the overlapping situations in
which the young person finds himself. Inconsistency in adolescent behavior
not infrequently occurs because sometimes the determinants of adult
behavior and sometimes the determinants of childish behavior win out.
When the person cannot satisfy both his childish and more mature inten-
tions at the same time, there is the likelihood that anxiety, frustration, and
heightened emotionality will ensue. Also, the uncertainty of the adoles-
cent's role may lead to exaggeration either of adult behavior or of the
childish component, whichever is deemed the most valuable at the particu-
lar time. Not all overlapping situations lead to disruptive behavior, how-
ever, since it is possible for behavior appropriate to each to be compatible.
This is seen, for example, in the adolescent who plays childish games
(child situation) with the small boy left in his charge (adult situation).
* For a systematic account of the properties of overlapping situations and
the consequent behavior in adolescence see Barker et al. (1953:37-45).
The Adolescent with a Physical Disability 183
The concept of the overlapping situation has been found useful to
describe not only the psychological world of the adolescent but also, as
we have seen, that of the person with a disability who is exposed to the
pressures of what may be called the "disabled determiners" of behavior
and "normal determiners" of behavior (see p. 16). Where these
determiners are incompatible, theninconsistent, emotional, and exaggerated
behavior can be expected to result, depending on the particular constella-
tion of forces. For example, a person with impaired hearing may show
inconsistencies in his use of a hearing aid when he wants on the one hand
to act as though he were nondisabled (normal determiners) and yet also
to wear his prosthesis in order to participate in conversation (disabled
determiners). Emotion may be expressed in the aversion a person feels
toward his braces. And exaggerated behavior may be evidenced when a
person with a wooden leg refuses help in situations of ordinary courtesy.
We have used the verb "may" here because the same overt behavior may
be due to divergent factors. Thus, help may be refused in situations of
ordinary courtesy, not necessarily because of the operation of conflicting
overlapping situations but because the person may want to take every
opportunity to learn on his own.
For an adolescent with a disability, two of the more lasting and prob-
lematic kinds of overlapping situations will be those due ( 1 ) to the opera-
tion of "child" and "adult" determiners of behavior and (2) to the
operation of "normal" and "disabled" determiners. The following two
incidents are taken from the autobiography of Frances Warfield (1948),
who, it may be recalled, struggled against a progressive hearing loss
throughout her adolescence. The first is an example of overlapping situa-
tions in which child and adult determiners of behavior operate at the same
time; the "adult" situation representing freedom and independence is
clearly positive, the "child" situation clearly negative. The resulting be-
havior is an exaggeration of behavior symbolic of adulthood. The incident
took place when Frances was visiting England upon graduation from
college:
I began going alone around London, poised and journalistic, I and my one-
dollar Certificate of Newspaper Credentials. Anna Mary [a college-mate] was
jealous. If only she had a job ahead, she grumbled. If only she could be free
and independent, as I was, to go around having adventures.
I loitered at No. 10 Downing Street, and was rewarded by a glimpse of the
Prime Minister. Paying tribute to the Peter Pan statue in Kensington Gardens,
I saw a man who might well have been Sir James M. Barrie. I walked up to
the bar in a pub in Hammersmith and ordered Guinness because I'd read it was
the ruin and solace of London charwomen. It was dark, sickish stuff, but I
forced it down, feeling every inch a roving journalist, smoking a Gold Flake
cigarette. That was the first time in my life I ever smoked a cigarette in public.
184 Physical Disability — A Psychological Approach
though, like all my friends, I had been smoking surreptitiously for several
years. Just imagine Aunt May's and Aunt Harriet's faces if they could have
seen me standing in a London pub drinking Guinness and smoking a cigarette!
Judas Priest. I was so tickled that on the way home I stopped in a swank shop
in Bond Street and bought myself a small pipe [pp. 72-73, italics added). ^
In the next example, the overlapping situations are directly related to
Frances' disability. It is during adolescence that the conflict between the
"normal-disability" determiners of behavior often becomes acute, for it
is during this period that physique tends not only to assume a heightened
importance but also to become rigidly standardized as to what constitutes
appropriateness. As a person in the "disabled" situation, Frances should
say, "What? Speak a little louder, please." As a person in the "normal"
situation, she should carry on a smooth conversation. But Frances at this
time in her life was both kinds of people. Though the former was negative
and the latter positive, Frances' physical status did not permit her to act
in accord with the normal determiners of behavior to the exclusion of the
disabled determiners. Instead, the behavior required by each of the situa-
tions was modified by the other, resulting in such "solutions" as dominat-
ing the conversation and double-talk. Notice, too, the manifestations of
emotionality resulting from the conflicting situations. Frances is now 14:
I had learned by experience to do all the talking when I walked along the
street with a boy. Indoors I could keep voices raised by playing the victrola;
outdoors I was in danger of missing what was said. I always walked fast,
rattling on at random, trusting to luck that when a boy wanted to ask me to a
dance he'd call me on the telephone.
But this time my tongue was tied — transfixed between fear that Roger was
going to ask me to the dance (he'd be sure to mumble) and fear that he had
already asked Pamela.
He said, "Hello." We scuffed along in silence. My heart jolted against my
red sweater and my ears set up such a roaring that I couldn't have heard a fire
alarm at ten paces. When we reached my gate, Roger asked me a question. It
might have been about algebra. It might have been about football, fudge, or
fiddlesticks. It might have been about going to the dance.
I opened my mouth but nothing came of it. What could I say? I certainly
wasn't going to say "What?" Well, hardly. And risk the Seven Deadly Words?
Risk having a boy — and Roger Evans of all boys — jeer, "What's the matter —
cotton in your ears?"
Mentally I ran through my standard dodges — feeling faint, being absent-
minded, and so on. They wouldn't do. A big dance was at stake. And I couldn't
just stand there.
5 F. Warfield, Cotton in My Ears, New York, Viking Press, Inc. Copyright
1948 by Frances Warfield. Used with permission of Viking Press, Inc.
The Adolescent with a Physical Disability 185
I swung the gate back and forth. Suddenly I exclaimed, "Wrinkelohwrinkellet-
downyourhair!" [Wrinkel was an imaginary childhood companion that always
came to Frances' aid.]
"Say, what kind of lingo's that?" Roger demanded.
"Wrinkelingo."
"What's wrinkelingo?"
"Wrinkeli wrinkelthink wrinkelyou wrinkelare wrinkela wrinkelprune," I
improvised glibly.
"Come again?"
I repeated it, swinging the gate confidently.
"Wrinkelprune yourself, smarty," he said.
"Yah, wrinkelsap." I swung the gate to and started up the walk.
Roger telephoned that evening and wrinkelasked me to the wrinkeldance
[pp. 24-25].
The adolescent with a disability, then, has to cope with two kinds of
persisting overlapping situations, that owing to his disability and that
owing to his transitional status as a child-adult. The conflicting nature of
the former will be reduced in frequency and intensity to the extent that
the person has stripped his disability of shame and inferiority. It may then
exist as being imposed from the outside, in which case the rebellion is
against those forces instead of against the self.
The overlapping situation of childhood and adulthood may persist
beyond the usual span of years, and in fact may recur as more than one
episode in the lifetime of an individual. Whenever the individual is pulled,
in crucial situations that are more than fleeting phases, by both the
emotional patterns of childhood and those of mature adult self-responsi-
bility, he is caught up by the need for reevaluation of the self typical of
the adolescent.
Moreover, whenever the "rites" of adulthood are denied or postponed
(as may occur where a disability exists), the adolescent marginal position
tends to persist. In very simple societies children have completed their
acceptance of themselves and their roles in life by the time they are 6 or
7 and then must simply wait for physical maturity to assume a complete
role (Mead, 1949:361). In our society, the status of full adulthood is
generally withheld until the advent of two outstanding circumstances:
economic independence and marriage. For some individuals, additional
accomplishments are necessary before they and others accept their claim
to full adult status: parenthood, being a property owner, admission to a
fraternal order, and other symbolic attainments fall in this class. For
others, no matter how many symbolic prerequisites are attained, the
dependency relationship between parent and child is never outgrowTi and
consequently they do not feel adult. The establishment of a separate
household, so much the American ideal, is the outward sign that the
1 86 Physical Disability — A Psychological Approach
person has assumed the responsibihties of marriage, has become eco-
nomically self-sufficient, and has become emotionally independent of
parental authority.
Where circumstances prolong the period of economic dependence,
postpone marriage, or disallow sufficient emotional separation from the
parent, then the position of the individual as an adult, no matter what his
age, is apt to be tenuous and, like that of the adolescent, marginal between
adulthood and childhood. He may well continue to experience conflicts
with parental authority resulting from such marginality, to feel devaluated
as an incomplete adult, and to show inconsistent, exaggerated, and
emotional behavior typical of conflicting overlapping situations. It may
very well be that the fact of disability in many cases tends to prolong the
adolescent period.
THE ADOLESCENT PEER GROUP
The discrepancy in the perception of adults and adolescents concerning
the appropriateness of adult and child determiners of behavior in different
situations is one of the keys to the understanding of the tremendous
importance that the peer culture assumes during adolescence. The adoles-
cent often regards the adult as being the barrier to his attaining the status
of full adulthood. Until recently, in the adult-dominated world of school
and home, he may have enjoyed the privileges of being an older and more
responsible child, whereas now his self-esteem may be shaken by those
same adults with whom he has no standing as an adult.
The simplest type of negative response to the perceived agents of frus-
tration is direct aggression. "Hence arise hostile and defiant attitudes
towards adults and adult authority, contempt for adult goals and values,
and cynical philosophies of life" (Ausubel, 1952:93). But the adolescent
does not generally have the inner fortitude to carry on the attack by
himself. Moreover, his deflated ego as a marginal adult needs propping up.
The necessary support is found in the adolescent peer culture. "Through
the force of numbers, precedent and organized resistance, it is able to
protect the individual adolescent from excessive encroachments of adult
authority" (Ausubel, 1952:94). And "through its power to confer
recognition and prestige, it provides a rich compensatory source of status
which is partially capable of restoring damaged ego adequacy" (Ausubel,
1952:93).
The demands for conformity of dress, behavior, and speech by adoles-
cents have been commented upon by many authorities. These demands
serve to delineate the group from both adults and children and to produce
a group solidarity that may be helpful in the search for self-assertion and
The Adolescent with a Physical Disability 187
independence. The adolescent peer culture can provide strength and
comfort to the adolescent who is a part of it. It also is a source of distress
for the individual who strives to join but cannot either because he is
rejected by the "gang" or because of inhibitions within himself. We do not
know how many adolescents are outcasts, but probably many if not most
adolescents for shorter or longer periods of time during these maturing
years experience the loneliness of not fitting anywhere. If rather strict
conformity to the adolescent fashions is a necessity, it is not difficult for
any adolescent to notice some way in which he deviates. It might also
seem, therefore, that the young person with an obvious disability is at a
disadvantage in becoming part of a peer group. Unfortunately there are
as far as we know no systematic data concerning membership in peer
groups, either for adolescents with disabilities or for those without.
There is one experiment on deviation and rejection that is pertinent
though it does not deal with physical deviation (Schachter, 1951). The
problem concerned the reaction of a group to the deviation of a member
from the group norms, the deviation being in one case relevant to the
group's purposes and in the second case irrelevant. Cohesiveness of the
group also was varied. The experimental design itself is a good example
of controlled research that at the same time is suggestive for experimental
application to problems involving physical disability and will therefore be
reported in detail here:
The experiment was conducted as the first meeting of a club. Four types of
clubs were set up, each representing a different degree and combination of
cohesiveness and relevance. In each club, paid participants deviated from or
conformed to an experimentally created group standard. Discussion in each
club was systematically observed. At the end of each meeting members were
nominated for committees, and sociometric rankings of persons whom the
subject would like to have remain in the club were filled out. These served as
measures of rejection.
The four types of clubs set up were case-study, movie, editorial, and radio
clubs. The first two were highly cohesive groups, being made up of students
who were interested in them; whereas the latter two were low-cohesion groups,
comprising students who showed little or no interest in joining them. There
was a total of 32 clubs, eight of each type. Each club had from five to seven
members and three paid participants who were perceived as fellow club mem-
bers. All the subjects in the clubs were male college students.
In a typical meeting, each club member read a short version of the life
history of a juvenile delinquent that ended as he was awaiting sentence for a
minor crime. The leader of the club, in aU instances the experimenter, asked
the members to discuss and decide the question, "What should be done with
this kid?" This question was relevant to the announced functions of the case-
study and editorial clubs, but irrelevant to the movie and radio clubs.
The discussion was guided by a 7-point scale ordered along a love-punishment
188 Physical Disability — A Psychological Approach
dimension that was made up of alternative suggestions as to ways of handling
the delinquent. It was introduced to the club members as a convenient device
for learning everyone's position and for channelizing discussion.
The case was written sympathetically to ensure that there would be a deviate
position. In all clubs almost all members chose positions on the scale emphasiz-
ing love and kindness (positions 2-4), and the deviate chose the position of
extreme discipline (position 7). After reading the case, each club member
announced the position on the scale that he had chosen. Then came the three
paid participants. The "deviate" chose a position of extreme deviation and
maintained it throughout the discussion; the second, the "mode," chose and
maintained the modal position of group opinion; and the third, the "slider,"
chose the position of extreme deviation but allowed himself gradually to be
influenced, so that at the end of the discussion he was at the modal position.
The discussion, limited to 45 minutes, was largely a matter of thrashing out
differences of opinion among club members. After 20 minutes, the leader took
a census to ensure that everyone was fully aware of everyone else's position,
and did so again at the end of the discussion. Then the leader turned the
discussion to the future of the club. At this time the committee nomination
blanks and sociometric questionnaires were filled out.
The finding most pertinent in our context is that the deviate — namely,
the person who took an opposing position and maintained it in the face
of increased efforts on the part of the group to change his position — was
rejected in all experimental conditions. The rejection was less in the groups
in which the task was irrelevant and the group cohesiveness was low. The
deviate was rejected more strongly than the "mode" (the person who
took the typical position of the group) and more strongly than the
"slider," the person who started with a deviate position and shifted under
persuasion to the modal position. The sociometric data revealed that the
deviate was nominated for undesirable committee jobs rather than for
desirable committee jobs. This could mean that the deviate is seen as less
desirable as a group member and less competent as an officer than either
the "mode" or the "slider."
This type of experiment should be carried out with physical disability
as the deviation, since it is not possible to equate a physical deviation that
is by nature unchangeable with an attitude deviation perceived as being
capable of change by persuasion or other means. In such an experiment,
the variable, relevancy, could be manipulated by the type of club used. A
sports or social club of adolescents in the relevant case and an editorial
club in the irrelevant case would permit the physical factor to be used as
an independent variable. One could postulate that the results would show
that, as in Schachter's experiments, rejection by the group of a person with
a physical deviation is not all-pervasive and indiscriminate but is ex-
perienced most strongly in that group in which ideal physique is most
The Adolescenf with a Physical Disability 189
relevant. Such a finding would support the personal experiences recounted
by adolescents with disabilities who bring out that they suffer rejection
most keenly in matters of courtship and marriage — i.e., the interpersonal
relationship par excellence where conformity to standards is felt to be
essential.
A careful analysis of several autobiographies of persons with dis-
abilities (Baker, 1946; Brown, 1955; Carison, 1941; Criddle, 1953; Gold-
man, 1947; Ohnstad, 1942; Viscardi, 1952) strongly suggests that the
conforming demands of the adolescent can make allowances for physical
deviations in many kinds of group situations. In only one of the seven
accounts did the adolescent lack group companionship, and that was the
case of Christy Brown (1955) who was profoundly incapacitated physi-
cally because of cerebral palsy. Each of the other personal documents
reports a good deal of activity at work and at play with other young
people.
Yet these accounts also reveal a deep and sometimes overwhelming
loneliness. Each of the adolescents had to face and in some way to cope
with the rigid conformity demanded in the vital area of sex appropriate-
ness. These young people were lonely not because of the lack of friends,
but because they could not share in the attachments of boy-girl relation-
ships. The conviction that they could never enter the adult estate of court-
ship and marriage dawned at adolescence and did not disappear until the
horizons widened to include other values besides physical conformity as
criteria for sex appropriateness.
The pattern of adequate companionship along with frustrating boy-girl
relationships repeats itself in these personal documents. Carlson (1941),
a severe spastic, had three faithful friends with whom he played and
studied. He did not lack companionship, but he did miss social life and
the feeling of manliness thereby denied him. It was not until his middle
twenties that he enjoyed "a great increased sense of personal worth,
thanks to having won the affection of a girl for the first time in my life"
(p. 71) .^ And the feeling of being part of the community of men was his
also for the first time: "He who has thought of himself as being cut off
from the rest of mankind by his handicap suddenly discovers that the
barrier has vanished, and he idealizes the girl who has released him from
isolation" (p. 71). Even young Louise Baker (1946), a vivacious and
popular girl with one leg, who was president of one group or another
twelve times before she was graduated from high school, suffered the
frustration of believing herself "all wrong" and unwanted because she
« Quotations from Earl R. Carlson, Born That Way, 1941, by permission of
The John Day Company, publishers.
190 Physical Disability — A Psychological Approach
"knew" that she could never get a husband (though subsequently she did,
and more than once).
There is, however, no systematic evidence to indicate that young
persons with disabilities have more troubles in heterosexual adjustments
than other young people. Landis and BoUes" study {1942), discussed
earlier in a different connection, is the most systematic in this area. It
investigated specifically the psychosexual development of women with
physical handicaps as compared with physically normal women. The
subjects were 17 to 30 years of age. Ratings were made on the basis of
controlled interviews. On the characteristics listed below, the group with
handicaps differed from the normal groups:
Hand
First knowledge of sex differences
before age 6
Complete sex infornnation before
age 1 5
Little or no preparation for
menstruation
No history of masturbation
Extremely close to family
No evidence of homoerotic behavior
Never been in love
Never had dates with boys
First date before age 16
No evidence of masculine protest
Recalled a desire to be a boy
in childhood
Attitude of disgust toward sex
Source: Adapted and abridged from Landis and Belles (1942), p. 154.
From these and related data the authors conclude that, in comparison
with physically normal women, those with physical handicaps are less
autoerotic, are emotionally more dependent on their families, are less
homoerotic, have fewer heterosexual contacts, give less evidence of
masculine protest, have equal narcissism, and are less emotional about sex
in general. These findings may shed some light on the fact that the blind
adolescents in Sommers' study (1944) were no more concerned about
finding a boy or girl friend than were the seeing controls. Even though
the Landis and Bolles women with physical handicaps were slower in
Percentagf
3 of
Physically
Icapped
Normal
1 1
33
11
26
78
55
74
50
23
3
23
8
30
3
28
1
18
52
43
26
43
69
7
21
The Adolescent with a Physical Disability 191
dating and falling in love than were their normal controls, they also were
less emotional about sex in general and in some ways had fewer knots to
untie, such as autoeroticism, homoeroticism, and masculine protest.
In sum, autobiographical accounts indicate that, during adolescence,
persons with disabilities experience trying times in heterosexual adjust-
ments but evidently this is equally true of adolescents in general. We are
forced to conclude that there are many, many factors that enter into the
creation and resolution of problems; that though physical deviation may
not be the least of these factors, neither is it the greatest; and that some
factors may balance out others in the resultant effect on heterosexual
adjustments. The adolescent with a disability who is convinced that his
difficulties in forming boy-girl attachments would be obliterated were it
not for his disability would do well to realize that many if not all adoles-
cents have problems in this area which may be no lighter than his own.
The knowledge that "someday you will meet the person meant for you,"
as Russell Griddle's (1953) mother often repeated, may be of small
comfort to the adolescent who needs reassurance now, whose personal
experiences spell a different conclusion, and for whom rigid standards of
sex appropriateness are part of his own values. Yet, even though knowl-
edge may offer little conscious support, it may become part of a sub-
conscious sustaining repertoire, drawn and leaned upon as needed, and
therefore ought to be made available to the young person. He should know
that physical conformity will not always remain so important a criterion
for sex appropriateness. He should know that, for most persons with
physical disabilities, courtship and marriage are not forever closed, though
they may have to be delayed.
Such data as the following may speak louder than words: In one study
of almost 2000 employees with various disabilities, the marital status was
reported as follows (Brighouse, 1946) :
Percentage Married
Type of Handica
P
Males
Fema
Auditory
69
51
Cardiac
62
60
Hernias
78
Orthopedic
52
52
Respiratory
53
57
Visual
64
54
Multiple
68
52
All physically handicapped
61
55
Physically normal
con
troi
group
71
49
192 Physical Disability — A Psychological Approach
In another study on the personal and social adjustment of more than
400 former poliomyelitis patients whose present ages were 16 to 42 years,
about 28 percent of the men and 41 percent of the women were either
married or actively contemplating marriage (Lowman, C. L., as reported
in Barker et al., i955;130-131). The percentage of persons with varying
degrees of disability among those married and among those unmarried
was:
Married Unmarried
Very apparent 34 55
Moderately or slightly apparent 34 40
Not apparent or no deformity 32 6
Both sets of data show that heterosexual adjustment is within the realis«
tic outlook for persons who have a disability. Although there is some
relation between severity or apparency of disability and marriage, the
relationship is not strong.
Where the nature of the disability, however, is of such proportions that
the probability of marriage is very remote, the person himself has time to
absorb this realization, and to go on from there, Christy Brown (1955),
for example, the boy severely affected with cerebral palsy, recalls his
adolescence as mostly being a series of frustrations. He was terribly lonely,
and his life seemed without purpose or worth. He loved a girl and then
another, but of this he could only dream and never really partake. These
experiences, however, were not pervasive. Other experiences enabled him
to scale the high walls that were still around him and, as he achieved some
degree of physical independence, encouragement to write, and under-
standing from those who listened to him and respected him as a person,
his old bitterness changed to an acceptance. In his account, published
when he was 22 years of age, Christy Brown notes :
... I wanted so desperately to love and be loved, but — it was a bitter realiza-
tion, but a true one, a necessary one. What good would it do me if I were to
shut my eyes and turn my back on every unpleasant fact about myself? I
was tempted to do that many times, but I was only putting off the final
ordeal a little longer; it had to come sometime. It came: it made me sad,
bitter for a time, but in the end it also made me stronger within myself. If
I could never really be like other people, then at least I would be like
myself and make the best of it [p. 128].'^
At the time of the writing, Christy Brown had not achieved the adult
7 Christy Brown, My Left Foot. Simon and Schuster, Inc., 1955. By
permission.
The Adolescent with a Physical Disability 193
prerequisites of economic independence and marriage. That this will
protract the adolescent situation of being neither a child nor an adult is
quite certain. That this will maintain his present conviction that he will
"never be a normal individual leading a normal life" (p. 128) may very
well be. And yet, it is also certain that Christy, as he continues to integrate
his experiences within reevaluations of the importance of things and the
values in life, will continue to realize that "it was this very affliction, which
I regarded in my worst moment as a curse from God, that was to bring a
strange beauty into my life" (p. 124).
The adolescent who does not have age-mate companionship, whether
he has a handicap or not, needs help in providing opportunity for such
relationships. The crucial questions must uncover reasons for the isola-
tion. Sometimes the basic causes may be removed from any physical dis-
ability itself, as when the individual withdraws within himself and does
not welcome other children, or when geographic distance acts as a barrier
to ready companionship. Sometimes the effects of a disability may directly
act as a deterrent, as in the case of severe physical dependence, where
the child is for the most part homebound, or in the case of a young person
who avoids social relationships because of deep shame over his disability.
The steps taken to ameliorate the situation in each of these instances will
obviously be different.
Undoubtedly, data will eventually show large variations in adolescent
peer life among the group with disabilities as well as among the group
without. Probably most adolescents, for one reason or another and for
briefer or longer duration, experience the gnawing feelings of loneliness.
Assuredly, not all persons need to feel part of a sizable group to satisfy
the need for support and companionship. One friend may be sufficient.
Finally, it is likely that the adolescent with a disability is able to find age-
mate companionship more easily than to establish his status as a man or
woman. Evidently, a physical deviation need not threaten the peer group
in its supportive and status-giving functions, even though it may threaten
role suitability for marriage.
THE CASE OF RUSSELL CRIDDLE:
AN ADOLESCENT WITH A DISABILITY
Let us examine in some detail the adolescence of Russell Griddle
(1953), who traces with utmost sincerity the course his disabihty took in
the adolescent search for self-respect and independence against opposing
forces. The vision of this boy, you may recall, became so seriously
impaired at the age of 12 that he could not see to count his fingers at
more than 2 feet in a good light, and in order to read ordinary print had
194 Physical Disability — A Psychological Approach
to bring the book to within 2 inches of his eyes. Legally he was declared
blind. During the next 17 years, when his vision was temporarily restored
by a corneal graft, he fought a constant battle against being what people
thought a blind person should be — namely, thoroughly incapacitated,
overprotected, and ineligible as a marriage partner.
In the narration, the following significant points are detectable: (1)
As Griddle's physique took on new meanings in adolescence, his self-
concept became altered too. The processes of differentiation and integra-
tion are seen throughout these reevaluating years. (2) Criddle was by no
means an isolate. He had friends to play with and to study with. (3) Yet
he often knew a deep loneliness. In his preadolescence, this was felt when
his disability kept him from participating in group activities. During his
adolescent years, the loneliness became more firmly welded into the con-
viction that he could not secure the affection of a girl. (4) He had contact
with girls, but except for short-lived and tenuous emotional ties, the rela-
tionships were (until his middle twenties) strictly "at a distance." (5)
Like other adolescents, he rebelled against adult — particularly parental —
authority, and had his teen-age gang with whom to rebel. (6) But in his
struggle to meet the conflicting demands of the "normal" and "disabled"
overlapping situations he was on his own for the most part. His mother
was a source of comfort, but "solutions" evolved directly from his own
experiences. (7) Two main factors combined to protract Russell Griddle's
position as an adolescent. The first of these was the girl problem, which
denied him the status of a suitor and eventual husband. The second was
his extended economic dependence on his family, brought about by the
depression years and exacerbated by his disability.
The following account is divided into age groupings that span significant
changes in Griddle's life.
Age 12-13. This was the period of Griddle's initial adjustment to his
disability and reinstatement, to some extent, with his gang. He did not
think of himself as tragic, for he had his mother's assurance, supported by
childhood's belief in the future, that his eyes would get better. But the
months following his accident had been lonely months. The fellows had
come around often at first, but after a while their visits dwindled until
the older boys seldom came at all.
Soon he came face to face with the awful social consequences of blind-
ness when he was openly rejected by his gang. From then on he denied
that he was blind, though he was willing to admit that his eyes were bad,
for blindness meant to him exclusion, dependency, and inferiority.
Griddle was correct in believing that the overlapping situations of
normality and disability were not as incompatible as the stereotype of
blindness would make them. But he was not correct in believing that
in the long run the incompatibility would be obliterated by attempts to
The Adolescent with a Physical Disability 195
conceal and even deny the latter and "acting as if" he were fully a part
of the former. This solution, "acting as if," begun early in his career as a
person with a disability, persisted for almost a decade until the wisdom of
experience thrust upon him the folly of his pretense.
Criddle did become reinstated with the gang as a result of his own
perseverance and the support of the gang leader, who ruled, "As long as
you got guts you're still a member, even if you are blind" (p. 21).
The initial, almost complete isolation gave way to a fair amount of
group participation:
... I can remember sliding down a steep clay bank that provided a ten-
foot chute into the river [with the other fellows]. . . .
I was the bat boy at ball games, though we only had one bat. I can
remember hanging by my heels from the high strut of a billboard, in a game
of follow-the-Ieader. I was the only one in the gang who could hang by
his heels.
We played hide-and-seek. I could hide but I couldn't seek, so I gave the
last one caught before me the privilege and pleasure of giving me ten
punches in the arm, in exchange for his taking "it" for me [p. 31].8
There were other occasions, and frequent ones, however, when Criddle
felt alone and out of things:
. . . there were the long, lonely hours, too, while the gang was playing
some game I could not join in. I never resented their playing in the woods,
or going fishing, or doing any of the hundreds of things I could not do
without spoiling their play. I learned to be realistic and to play by myself
while I waited out the hours and days between games I could take part in
[pp. 31-32].
With respect to his family, Criddle sensed the sympathy and under-
standing of his mother and in turn loved her deeply. Throughout this
period and those to follow, she helped him extend his space of free move-
ment in spite of pressures from the community to overprotect and inhibit
him. Other forces worked at sharpening the incompatibility between the
overlapping situations of normality and disability. His mother worked
toward destroying the incompatibility:
Mother knew what I sensed. That the difference between not being able to
see and not being blind was in not being what people thought a blind person
should be. She had a problem, too, in not being what mothers of blind chil-
dren should be. The neighborhood felt that she was being criminally negligent
8 Reprinted from Love Is Not Blind by Russell Criddle. By permission of
W. W. Norton & Company, Inc. Copyright 1953 by Russell Criddle.
196 Physical Disability — A Psychological Approach
in the way she allowed me to go about, playing, swimming, crossing streets, and
all, and they were not reluctant to tell her so. "If that boy gets killed," I heard
one irate neighbor say, "his death will be on your hands."
"I know," Mother answered quietly, "and if he doesn't, his Ufe will be on my
hands. I must let him live, don't you understand? Bad eyes don't make a boy
into an old man" [p. 36].
Griddle's father provided for the family, but otherwise during this early
period entered little into his son's life. The two brothers were enough
younger to have their own gangs and Criddle did not often join them.
Age 13-14. As a whole, this was a lonely year for Criddle. The other
boys were at school, but no sight-saving classes were available and Criddle
found "life in the world of adults unbearably lonely" (p. 46) . Occasionally
he still boxed, skated, and went swimming with the gang. Through his
mother's efforts, he was able to get a newspaper route. Criddle recalls the
affectionate relationships among the family members, and makes repeated
reference in this and later years to his mother's wisdom in rearing a
handicapped child.
Age 14-15. During this year Criddle became increasingly aware of girls
as a special object of interest but had not yet fully realized the barrier
character of his disability in this regard. This was his first year at a sight-
saving school in a nearby community, which he attended until the age of
16. Evidently his days were well filled with the activities at school, but he
refers very little to his peer life there. He did have his first "love affair" at
this school with a girl two years his junior. When she confessed her love
for another boy, Criddle did suffer intensely. But, because he still held
the childish belief, inspired in part by his mother, that eventually he would
be able to see as well as ever, he was able to assuage his ego by blaming
his handicap. Moreover, during this early part of his adolescence, Red, a
good friend and a physically unimpaired member of the gang, was no
great shakes as a Don Juan either, and at social affairs outside of school
"Red and I were quite satisfied both with the cool kisses that we got from
the girls whenever one of them accidentally called our numbers [at kissing
games], and with the necessity of going stag" (p. 52). Criddle also could
chalk off his apparent lack of sex appeal to his relative youth.
Age 15-16. It was this year that brought about some of the most
drastic changes in Criddle's concept of himself as an adolescent. His
accustomed role as a child to be protected by his parents was jolted and
the fear that he could never be loved by a girl descended upon him.
The rude awakening of a changed role between himself and his parents
occurred when Criddle engaged in a boxing match with his father. This
started as playful sparring and ended up as a serious battle for superiority,
Criddle becoming the victor. With this incident the potency of his adult
The Adolescent with a Physical Disability 197
position greatly increased, and that of his child position weakened. The
conflict over giving up personal security as the price of independence is
clear:
Bruised and horribly fatigued, I made my way to the old camp site. . . . The
camp was gone, its ruins having been salvaged by another generation or another
camp. It seemed to signify my lost childhood. I didn't want to have licked my
father. I didn't want to lose the protection his superior strength had given me.
I didn't want to grow up. I didn't want to know that now I no longer need obey
him for fear of punishment. I didn't want to lose the protection of his authority
over me. Now I was a man, but I no longer had him to go to, and I felt
ashamed of the tears that burned on my battered face.
I wanted to go to Mother, to have her nurse me as she always had, but when
the fight was over she had run out of the front door from where she had been
watching and had gone directly to Dad. She had disregarded me entirely, and
I had to accept the fact that her first concern was for him rather than for me
[pp. 60-61].
With the gradual estrangement between himself and his parents that
grew in the succeeding years, Criddle increasingly needed affectional ties
with a girl to fill the void. But the problem of girls, with which he had
been so happily unconcerned, developed during this period into the
anguished conviction that the love of a girl could never be for him. His
earlier rationalizations no longer worked. The adolescent's regard of his
physique as being the culmination of a series of changes prevented his
seeking consolation in the hope of major improvement with his eyes.
Repeated experiences of a subtle advance and a subtle rejection convinced
him that he was an unwanted person in boy-girl relationships. Not so
subtle rejections and the incident recorded earlier (see p. 4) made his
conviction indelible, though his hope kept alive the remote possibility
that he was wrong.
In coping with this conviction, Criddle began to reason that one need
not have children and a wife to be happy, that in fact one could enjoy
more of the "finer things of life" without the restrictions of a family. But
again the rationalization proved but a shallow covering for the relentless
yearnings underneath. The fact that he could not get a dance date still
foretold a life of loneliness for which he saw no alternative. The close of
this period sees the cementing of the irreversible coimection between lone-
liness and celibacy. He could not peer into the future of more than ten
years thence when physique would cease to be the all-important criterion
of sex appropriateness, when he would have matured a little and girls
would have matured a little, to make possible the fulfillment of his
mother's repeated reassurances that someday he would meet the girl
meant for him.
198 Physical Disability — A Psychological Approach
Yet, during this resigned 'oneliness, Criddle had friends. "Anywhere
from six to ten boys used to gather in either Red's cellar or my sitting
room, and spend an evening in good fellowship and sparring" (p. 58). As
an antidote for his loneliness his father tried to help him ". . . by making
me a man among his adult friends. He took me fishing a few times that
summer and though I tried to pretend to like it, he knew that I was bored.
He started playing checkers with me during the evenings that he was not
working, and v/e would have a stein of beer with the game" (p. 57). His
father's efforts offered little comfort, however, for besides being a poor
substitute for the real thing, Criddle felt that his father resented him
because of his handicap (as well as loved him in spite of it) .
The ambiguous and shifting light in which the parent of an adolescent
regards his son is seen when Griddle's father on the one hand extended
the symbols of manhood to him in offering the beer, and on the other
hand withdrew them in demanding a curfew. His adolescent conflict with
his father grew with the belief that his father required exaggerated virtue
from him because of his handicap. His mother, as seen by Criddle,
ordered him little and understood him always.
Age 16-18. Criddle's adolescent turbulence continued unchecked. He
started regular high school but, being two years older than his classmates,
he had little to do with them outside school hours. At best they left him
alone; at worst they rejected and ridiculed him (see pp. 245-246 for one
of the more trying incidents). He bent every effort to hide his disability in
order to be like anyone else, but only years later did he learn that such
play carried no trumps. His gang life continued with an occasional evening
of boxing and pinochle. He even made new friends and with the gang
made a stab at such concrete admissions of adulthood as gambling and
drinking which could, at the same time, represent frontal attacks against
authority. "Occasionally we would all chip in for a gallon of wine or a
bottle of cheap whiskey. We seldom had enough money to do much
damage" (pp. 65-66).
Criddle also saw in his escapades a bitter reaction against the loneliness
of not having a girl. With indignation he challenged his mother, "So I was
playing a little penny ante. What's wrong with that? The other fellows
have dates all the time. What am I supposed to do, stay home and listen
to the radio seven nights a week?" (p. 67). Criddle's parents continued to
worry about him and keep tab on him. Once when he had been gambling,
for example, his father went to the others involved and raised a row. He
told them that if it would happen again he would call the police. Criddle
resented the childish position this implied even though he agreed with his
parents that he was more than ordinarily derelict.
But the times that Criddle spent with his parents were also good. This
point is important: though parents and adolescents may often quarrel.
The Adolescent with a Physical Disability 199
there are times, not necessarily infrequent ones, when the bond of kinship
is strengthened by friendship. Griddle's father confided in him his own
youthful derelictions, taught him how to play the bugle, and continued to
play checkers and drink beer with him of an evening. All of this gave
Criddle the feeling that, in spite of his father's resentments, he was his
favorite son.
When Criddle joined the bugle corps with two of his cronies, his spare
time was well occupied with practice and performance. He was even
assured of the company of girls at the dance after the celebrations. But as
emancipation from the family increased with these new exploits. Griddle's
need for attachments with a girl could not remain dormant. He began to
reason that if he could conceal his handicap until after the girl had learned
to like him — then surely she could continue to like him!
This was a rather ambitious plan. That I could keep a girl from knowing
about my eyes through the intimacies of courtship, even a rapid one, seems
improbable. That I did seems a little fantastic even to me, now that I realize
how little I could see at that time.
This concealment became habitual. I would refrain from exposing my eye
condition as unconsciously as I would refrain from touching a fire; for it was
just as painful. People would notice something odd about me, but it was often
a long time before they realized what it was [p. 76].
Little did Griddle know that the adolescent, for whom physical con-
formity is the essence of sex appropriateness, could not see him as a
person aside from his disability. He had to be hurt and hurt hard before
his one hope in concealment, and with it his hope for happiness, was
shattered:
I remember Mary. I just happened to be standing on the corner of Fourth
and West Main when Mary passed on her way to school. The day before, I had
found her in music class — a new face, a new voice, a new hope, naturally to be
investigated. Bud told me that she lived just around the block from my house,
that she was a good-looker, and that she carried a heavy typewriter to and
from school each day.
And so, as I said, I just happened to be standing there when she passed. I had
been happening to be standing there some twenty minutes.
I pretended to be tying my shoe. Then I fell in behind her. I followed her
almost to Condon's store before I mustered enough courage to advance.
"May I carry your case?"
"Thank you," she said with genuine gratitude. "It is heavy."
She handed me the typewriter, and tossed her head to send long black curls
tumbling over her shoulder. She smiled. I watched her out of the corner of my
eye as we walked on. I could see a pert little nose, and she walked with a hit,
a sort of dance, but not ungraceful. Her whole personality seemed musical. I
200 Physical Disability — A Psychological Approach
would probably have walked the rest of the way to school in silence if she
hadn't spoken first.
"I know you. I saw you in music class yesterday. Your name's Russell."
"How do you know?"
"One of the girls told me."
I wondered if one of the girls had told her about my eyes.
"Did she tell you anything else?"
"She said you were a sophomore. I'm only a freshman. I take music with
the sophomores, though."
"I know," I said, "and your name's Mary."
She tossed her head again, and laughed, and I fell in love.
"Have you got a steady?" she asked after two more blocks of silence.
"No, I just broke up. Have you?"
"Sure. He's the hired man next to my daddy's farm. That is, he used to be.
My daddy doesn't have a farm any more. I was getting tired of him anyway."
"You're pretty," I said, trying to steady my voice.
She smiled her appreciation of my compliment, and said, "You're strong."
"Aw, this ain't heavy."
I held the typewriter at arm's length, to show her how modest I was.
We stopped at the Sugar Bowl that night. Mary had a soda (15(f), so I had a
dish of ice cream (10^). I only had a quarter.
Mary sipped her soda and looked at me for a moment, then, without warn-
ing, "You're nice."
I told her I was going to be a newspaper reporter some day.
"I think newspaper reporters are romantic."
We went to the movies on Sunday night, and had a soda afterward. We
walked home holding hands.
She liked horses. "My daddy had the best team of anybody," she boasted.
I laughed.
She turned abruptly and faced me. "Well, he did. My daddy said so."
"I believe you," I said.
We walked on, swinging our hands in time with her lilting steps. Then, "What
are you laughing at?"
"I don't know. You, I guess."
"You're an odd person," she said pleasantly, as we reached her front porch.
"What do you mean?"
"I don't know. Sometimes I look at you and you don't seem to see me."
"Let's just say I'm deep," I said, and we laughed.
"I think you're awfully nice," she said.
I wanted to kiss her, she stood so close. But I felt guilty, it wasn't right, not
telling her about my eyes.
I managed to keep Mary from knowing my eyes were bad through two
dozen sodas and three movies. I used every trick I had ever learned. I paid
special attention to the color of her dress each morning, and then I would
keep my eyes and ears and my sixth sense alert for anyone that might be Mary.
I didn't take any chances. If I wasn't sure, I would greet whoever it was with
familiarity. They probably thought I was nuts, but I didn't care. I always held
The Adolescent with a Physical Disability 201
her hand on the way to and from the movies at night, and she led me, without
knowing it, so I didn't have to feel for curbs and steps.
She said she had seen me in the hbrary one day and that I had fallen asleep.
I knew I had been studying, but I didn't tell her that.
"Why didn't you wake me up? Prof caught me."
She laughed and tossed her head, and the black curls tumbled about, and I
sighed with relief and ecstasy.
"Will you go to the firemen's ball with me?"
"Sure. I was afraid you didn't go to dances," she said.
I'll never forget that date. I thought I would have to sell my bike to get
funds, but Dad came through with the most beautiful five-dollar bill I have
ever seen. I took a bath every night for a week. I brushed my teeth until they
bled. My hair was plastered down with vaseline in the hope that it would
subdue the stubborn cowlick. Mother bought me a new pair of white flannels
and had my coat cleaned and pressed. I used up almost a whole box of shoe
poUsh on my best shoes. I wore Dad's brand-new hat, and his best necktie. I was
the essence of perfection as I straightened my tie and knocked at Mary's front
door.
Mary's mother answered. "Come in, Russell, Mary isn't quite ready."
I almost lost faith in the worth of living as I sat in the parlor with Mary's
mother, waiting for her beautiful daughter, for it started to rain. The awful
stuff hit the windows like hailstones. Mary's mother probably saw my anguish,
for she said:
"I think it will stop. They are big drops."
She was right. The rain had stopped when Mary came into the room. So did
time. She was wearing a pink dress, all stiff and crinkled, that flared out below
her slim waist and almost touched the floor. Enough perfume floated in with
her to glamorize a dozen girls.
I rose and helped Mary on with her coat. She had a pink ribbon in her soft
hair. Her eyes were almost black. I had thought they were.
"Come right home after the dance, and have a good time, children."
"Yes, Mother. Good night."
The rain had left the air clean and sweet, and Mary's perfume, thinned by a
soft breeze, wrought havoc with my co-ordination. The shower had washed
some of the greasy smoke from the town and part of it was left suspended in
puddles at our feet.
With my head in the clouds, I placed my number nine shoe directly into an
especially large one, splashing Mary's beautiful dress with the filthy water.
Mary uttered a httle scream of anguish, and the laughter left her voice as she
moaned a futile, "Oh dear!" I snatched my handkerchief from where I had
folded it so carefully, and dabbed at the wilting organdie, smearing it around
all the worse.
Mary groaned and pulled away. "Don't. Just let it dry."
We went on toward the hall. I kept apologizing, and she kept saying it was
nothing. I felt miserable as I "led" her, just a thought ahead of me, so that I
wouldn't have to feel for the steps up to the dance hall.
The gaiety of the ball soon dispelled the gloom. Nobody said anything about
202 Physical Disability — A Psychological Approach
her dress, so I guessed that it didn't look too bad. Mary danced close, and it
was evident to all that she was my girl. It was pure happiness for me. I felt
that Mary must somehow know about my eyes, the way she had acted about
the puddle, and besides, someone must have told her by this time.
We went to the Sugar Bowl during the intermission, and we each had two
sodas and a little piece of cake. After the dance, we went to the restaurant for
hot roast beef sandwiches and coffee. I was happy, indeed I was. Mary didn't
pity me. No one would pity me any more. I had a girl, a beautiful girl that
even Bud would have liked to have, if his steady didn't already have him roped
and tied. I had solved all my problems. People would no longer pity me, and
even if they did, what did I care.
Mary met me the next morning with a simple "hello" that told that I was her
beau. I didn't feel breathless any more; I felt contented, and happy. I looked
at her and thought how wonderful she was to be able to go with a guy that
nobody else would go with. It seemed to me there was no need to tell her
about my eyes, that she had probably known all the time. I felt differently now.
I didn't care whether anybody felt sorry for me or not. I didn't care whether
they thought I was stupid or not. I had a girl.
I met Mary after school with the same inexpressible feeling of intimacy with
which I had met her that morning:
"Hello. Where's your typewriter?"
"I left it in school."
We walked quietly to Main Street. Mary acted angry. She had never been
that way before.
"What's the matter?"
"Nothing."
But there was, I could tell. Her manner was chilly; the music was gone from
her bearing, the lilt from her step; and she was quiet. She had never been like
that before.
"If I did something, I'm sorry," I said.
"It's nothing."
We walked on, almost to Condon's store.
"I wish you would tell me."
She just said, "It's nothing," but she seemed to be melting a little. It wasn't
in anything she said, but her walk was a little less stilted.
Neither of us spoke again until we reached her house, and she would have
left me without even saying, "I'll be seeing you." I caught her hand.
"You've got to tell me. Something is wrong."
If I could have seen her eyes, I know I would have noticed that they were
shiny with tears. There was so much compassion in her voice when she finally
answered that I felt sorry for her.
"I'm sorry, Russ, honest I am. I knew you were kind of odd, but I didn't
know you couldn't see."
She pulled her hand from mine, and with a sob, ran into the shadow of her
front porch and I heard the door close behind her [pp. 76-83].
Griddle's misery was complete. He was now reconvinced, and this
The Adolescent with a Physical Disability 203
time without a shadow of a doubt, that no girl could ever love him. But
more than that, he felt he was only part of a man. It was as simple as this:
It takes six sides to make a hexagon, and a hexagon can hardly be expected
to fall in love with a triangle.
I'm a man in every respect but one, therefore I fall short of being a man
by definition. I can't expect to be desired as a man. But I have the desires of
a whole man. It's just nature [p. 113].
Fortunately, after two years in high school, Criddle began to find a
place for himself at school, and this served as a substitute to some degree
for his deepest pain at not being able to find a sweetheart.
Age 18-20. These two years were Griddle's first of relative peace since
the age of 14. He still missed the love of a girl sorely, but his gradual
acceptance by his classmates and his life on his father's farm to some
extent took its place. As a senior he was elected, by popular vote of the
student body, to become editor-in-chief of his high school paper. Of one
boy he says, "His acceptance of me had made my adjustment in school
easier. We were close friends, and an intimate understanding existed
between us" (p. 111). Nor did Criddle lack the companionship of girls:
But though I was without a sweetheart I was not without female companion-
ship. Girls seemed to respect and admire me. They liked me, as they told me
all too often, but not in that way. They wanted me for sort of a big brother.
They confided in me their conquests, their desires, and even their sins [p. 1151.
Aside from his improved social relations at school, his father's farm,
acquired during Griddle's sophomore year, kept time from hanging heavy
on his hands. Moreover, he gained the respect of the farmers and partici-
pated in the square dancing and movies of the rural community:
My hands blistered and toughened, and I grew hard until I could spend a full
day in the field and still have enough energy left for a square dance or a movie.
I gained their [the farmers'] respect as a good worker, which is the ultimate as
regards social status among farmers. I was respected. I was liked, too, I think,
and I liked them [p. 125].
Griddle was busy. During this period he reports no adolescent "flings"
or major eruptions with his father. But though his life was far from
empty, though he was productive and acclaimed, there remained an in-
completeness that kept begging for closure — his wish for a sweetheart was
intense. Griddle believed that he would not feel passion toward a sweet-
heart; that he would not desire anything from her other than companion-
ship, understanding and affection. He recognized that this was "a search
204 Physical Disability — A Psychological Approach
for someone upon whom to transfer the great love I had for my mother"
(p. 114). Though this incompleteness caused him great distress, it was
mild compared to the compounded sufferings he had to endure following
his graduation from high school.
Age 20-22. Upon graduation from high school, Criddle looked forward
to achieving economic independence and with it the dignity that was his
right. He achieved neither. The year was 1936, and times were hard.
After battling for employment, he did manage to hold two jobs briefly
but returned home sick and with the growing realization that his greatest
battle would be against society's proscription that as a blind man he must
live a life of asylum.
Emancipation from his family came slowly, and the inevitable parent-
child conflicts piled up. Just a short while before, Criddle had enjoyed a
fair amount of status as a promising reporter at high school and as a good
hand on the farm. Now he had no status at all, for since he was dependent
on his father, his father expected him to assume once again the sub-
servient position of a child. He argued, in effect, "See, without my help
you suffer. I will help you if you will do as I say." He beat Criddle
violently whenever he stayed out after one o'clock at night or committed
some comparable misdemeanor. And Criddle's reaction was to earn his
board on the farm as his father directed but otherwise ". . . Dad's decree
that I should do this or that was all the incentive I needed to disobey"
(p. 152). And like the adolescent who sees the parent as the main source
of his frustrations, Criddle recalls "I suppose I was normal enough to
blame all my troubles upon my father" (p. 152). Also like the adolescent
who needs some source of support for his rebellion and deflated ego,
Criddle sought out companionship wherever he could find it, whether in a
saloon or a pool hall, whether in a card game or at a dance. In short,
Criddle, who at the age of 18 was ready to abandon the adolescent
patterns of behavior for a more mature way of life, now in his twenties
was plummeted back to the typical psychological situation of an adoles-
cent with a consequent resurgence of adolescent behavior.
We tend to think of the adolescent as the one who strives for family
emancipation, and yet it is the parents, too, who work toward that end
in a way as uneven and ambivalent as the adolescent's striving for free-
dom. When, years before, his mother went to his father's assistance after
the fateful battle and left Criddle without comfort, she gave him a shove
toward independence. Now, when their relationships continued to go from
bad to worse, it was the father who ordered Criddle from the house.
The endless trail of job hunting began again. He did secure a few jobs,
but as soon as his supervisors discovered the condition of his eyes, he was
fired in spite of the fact, according to Criddle, that he could do a more
than adequate job. Society had the fixed notion that blindness so incapaci-
The Adolescent with a Physical Disability 205
tated a man that the only possibiHty of functioning at all lay in the
sheltered workshop. Criddle was revolted by what to him was a last resort,
for it meant giving up, a helplessness and dependency that he despised.
Instead he suffered cold and hunger and utter exhaustion; in humiliation
he returned after three months to his father's farm rather than agree with
society's verdict.
Age 22 to Maturity. By this time both Criddle and his father had
changed in ways that made living together less strained. His father had
learned, through the unsparing teaching of worry and remorse, that he
could not impose his will on his son. Criddle had learned that he could
achieve a greater freedom by admitting his handicap: "I know now that
the longer I kept people from knowing about my eyes, the greater became
the shock when they found out" (p. 159). And having been buffeted
around on the outside, he also could appreciate the relief he found in farm
life, where he was not repeatedly subjected to social prejudice. Both
parents welcomed him back and asked him to stay a while.
Criddle stayed. He worked on the farm during the harvesting season
and filled in during slack periods with selling radios and cutting mine
lagging. He had found some semblance of peace of mind. "That half of
the emotional barrier which had been within me was gone; I no longer
pitied myself" (p. 196). And then Criddle fell in love, in spite of having
resisted such an attachment for fear of being hurt again.
What drew these two people together? Winona was fat and Criddle
nearly blind. And each was ashamed of the other! In humiliation they
went out together because that was better than sitting home alone. Their
loneliness brought them together, and values deeper than physique drew
them together. They found they had good times together. They developed
a deep respect for each other, and mutual understanding flowered. They
overcame the adolescent hump that defined sex appropriateness in terms of
rigid standards of physical conformity. At last Criddle looked forward to
marriage and it. was this that made him savor the sweet nectar of full
adulthood. In spite of having become a resigned bachelor, he had felt that
every self-respecting farmer should be married. His vision of complete
status embodied the following:
My heifers. My cows. Rather I should say our cows. That is one thing about
farming, I thought: it makes a real partnership of marriage. Men have survived
all sorts of handicaps on farms, except that of being without a wife.
The horses stopped for a rest and I looked toward the house and smiled. The
next time I broke sod on this meadow, Winona would be there, in the house,
doing whatever was to be done, perhaps cooking dinner. And when I grew
thirsty she would seem to know it, and come out with a bottle of cool water,
and maybe a piece of bread and jam. She would stay for a moment, admiring
206 Physical Disability — A Psychological Approach
my work, and I would feel proud. She would probably bring some sugar for
the horses, and caution me not to work them too hard. Then she would start
back to the house, and I would call her back and kiss her.
I sighed at my dreams and started the team again. They would stand all day,
if I let them. Winona would be a wonderful wife. I smiled again as a car went
up the road. Today was Thursday and Mrs. Bryant was going to Ladies' Aid.
Winona would probably belong to the Ladies' Aid too. That meant that every
other Thursday I would have to get my own dinner, or eat something she
would leave covered on the table for me. I guessed that would be one of the
things I would have to tolerate. But the meetings always ended about four in
the afternoon, and she would be home in plenty of time to get a good hot
supper [pp. 207-208].
The picture painted a blissful marriage in a setting of economic inde-
pendence. Griddle's love for Winona provided all the motivation he
needed to prove that he could support a family by establishing and operat-
ing a dairy farm. With the help of his father he built a stable, a bam,
and a milk house. His emotional independence from his father leaped
forward: "Arguments with Dad didn't seem so important any more. I
could always cajole him, knowing that sometime he would go back to
town and I would be boss and could run things the way I wanted" (p.
208). An interim of deep unhappiness and loneliness still lay in store for
him, but the maturity he gained in this period of approaching adult status
helped him to withstand the onslaught of status loss he was to suffer.
When intervening pressures led Winona to reject his love several
months later, full adult status was again denied Criddle, but now, because
he had achieved the important prerequisite of economic independence, he
was less vulnerable to the conflicting pressures of a marginal person.
Against his father's wishes and assuming full responsibility, he bought an
adjoining farm that had a large farmhouse on it, for in the big house he
saw a chance to have a home of his own. As a substitute for what he
wanted most, he could at least "hire some widow, with a child or two, to
keep house" for him (p. 220). Occasionally he went out on a binge and
often drifted in search of a good time, for his need to establish himself
as a man and an adult remained unfulfilled. It was when circumstances
brought Winona to him again, when this time his romance ended in
marriage, that he found a contentment "which could not be marred by
pain, or fatigue or bitterness or any other thing" (p. 226). Economic
independence, marriage, a home of his own — Criddle finally came of age.
This discussion of some of the problems and solutions that the adoles-
cent may experience as his self-concept begins to incorporate the role of
adult, provides a background for understanding some of the special prob-
lems that an adolescent with a disability may face. He, too, undergoes a
The Adolescent with a Physical Disability 207
change of self-concept in which adult determiners of behavior as well as
childish determiners demand a hearing. He, too, will conflict with his
parents as these determiners vary in potency. And he will need the sup-
port of a peer group against the adults who are felt to thwart him. For
him, too, physique becomes evaluated in terms of rigid standards of sex
appropriateness and, like other adolescents, he has an intense interest in
all matters that have to do with the establishment of his status as a man
or woman. As in the case of other young people, the period of adolescence
may be prolonged by protracted economic dependence and celibacy. In
addition, the adolescent with a disability has to cope with the conflicts
engendered by the overlapping situation of "normal" and "disabled"
behavior determiners.
9
Chapter
Grievances and Gratifications in
Everyday Relationships
People live with people. They interact with one another in the
give-and-take of daily living. The interactions may leave them annoyed or
content, inspired or distraught, even though on more objective examina-
tion they may seem just small, routine affairs. But it is these small events
of everyday living, with their frictions and uplifts, that somehow season
the mood and condition the morale. They are important to the person
himself and to his relationships with others.
Persons with disabilities frequently refer to ordinary incidents that arise
with the nondisabled. They describe situations involving curiosity, staring,
help, sympathy, devaluating pity, being treated differently, social participa-
tion, and being taunted. There is hardly an autobiography that does not
bring up several of these incidents, sometimes as positive and sometimes
as negative experiences. It is important to uncover psychological condi-
tions that determine the acceptance or rejection of such relationships, for
it is an impossible task to provide recommendations for each and every
concrete social act that may arise.
The discussion will draw heavily upon the research of Dembo and her
associates. The findings of this study appear in several papers (Dembo,
Leviton, Wright, 1956; Ladieu, Hanfmann, Dembo, 1947; White, Wright,
Dembo, 1948; Ladieu, Adler, Dembo, 1948), but for ease of reference,
the research will here be referred to as the Dembo study. The basic
method of this study was an interview, usually lasting about an hour and
a half, aimed at uncovering the kinds of difficulties existing in the relation-
ships between persons with and without disabilities. The subjects were 177
adults with visible disabilities and 65 nondisabled. Of those with dis-
abilities, 100 were arm or leg amputees, 40 were cases of facial disfigure-
ment, and the remainder were distributed among such orthopedic
disabilities as poliomyelitis, transverse myelitis, osteomyelitis, and con-
genital deformities,
208
Grievances and Gratifications 209
THE PROBLEM OF CURIOSITY AND
DISCUSSION OF THE DISABILITY
The investigators of the problem of curiosity regarding a disability
point out that a disability as a characteristic and inseparable part of the
body may be felt by the person with the disability to be a matter that he
would like to keep private (White, Wright, Dembo, 1948). Yet its visi-
bility makes it known to anyone whom the person meets. A visible dis-
ability differs from many other personal matters in that anyone can deal
with it regardless of the wish of the person; anyone can stare at the dis-
ability or ask questions about it and in this way communicate his feelings
about the disability to the person. It is its visibility that makes easy an
intrusion into privacy, an intrustion that the person may feel powerless
to control or at best able to control only by how he reacts or handles the
situation.
The subjects of the Dembo study rejected curiosity about their disa-
bility for several reasons. For example, they spoke of wanting to keep their
disability private, of the unpleasantness of being reminded of painful
disability-connected memories, of the fear of being considered different, of
outright resentment at morbid curiosity. At the same time, it became clear
that the evaluation of communication about the disability depended upon
the circumstances in which it took place. Eighty-four percent of the
subjects neither fully accepted nor fully rejected questioning and talking
about the disability with nondisabled persons. Even staring, though
generally rejected, was still considered all right in certain circumstances
by one third of the subjects — for example, when it did not persist.
Conditions Underlying Evaluaflon
Several important factors emerged as contributing to the reaction of
the person with a disability to staring, to questioning of others about his
disability, and to their talking about it.
Self-regard was discussed at length in connection with the interpretation
of the behavior of another toward the self (Chap. 7). There it is pointed
out that, when the person has a well-balanced, accepting attitude toward
his disability, he is more likely to feel that others question him and stare
at him because they simply wonder about him — how he gets along, or how
his prosthesis works — than when he himself is ashamed of his disability.
If, however, the person basically rejects his disability and himself, he will
tend strongly to resist the curiosity of others, feeling that he is being
regarded negatively, with aversion and pity. His self-concept defines for
210 Physical Disability — A Psychological Approach
him the kind of person he is as an "object" of stimulation to others. He
may also actively resist speaking of his disability because he views it as
something to be ashamed of, a mark of inferiority, a skeleton to be kept
hidden.
There is also the factor of situational context that contributes to the
person's reaction. The subjects sometimes urged that others should not
talk about the disability unless it comes up naturally, meaning that
reference to the disability should be part of a broader conversation or
should arise out of the demands of the situation. Such references are less
likely to be felt as an intrusion into privacy. They are also less likely to
be felt as emphasizing the disability as such, but rather may be seen as
secondary to the purpose of the broader context. The peculiarly distasteful
experience of being stared at can be partially attributed to the fact that
it is not seen as emerging from a situational context; instead it is an
expression purely of the needs of the onlooker. Staring often goes on in
an extremely unstructured situation, so unstructured that it lacks a situa-
tional context. Under such ambiguous conditions the worst anxieties of
the person may come to the surface and determine the nature of his per-
ception. Should "extended looking" be required by the situation, as when
a doctor examines a wound, the activity is no longer thought of as staring.
Besides the situational context, there is also a personal context, repre-
senting the more lasting relationships between two persons. This accounts
for the marked tendency on the part of persons with disabilities to make a
distinction in favor of talking about the disability with friends or family
members rather than with strangers. The person with a disability recog-
nizes that his friends see him more frequently as a person whose personal
qualities are more important than his bodily appearance. He has less fear
that "it is not I but my disability" that is uppermost in the other person's
mind. Staring on the part of strangers represents in the extreme an im-
personal context. The very act of talking is to some degree symbolic of
a human relationship, but staring is a thing one does not ordinarily do to
another person. One does not talk to a monkey in a zoo or to a freak in
a sideshow — one only stares. As a result the relationship is easily per-
ceived as one of a person (the nondisabled) to an object — a curiosity.
The wish to be and to appear to be well adjusted, which may lead to
strong resistance against talking about the disability, sometimes may act to
diminish that resistance. The subjects often brought out their wish to be
considered "normal" and especially the wish to prove that they were not
defeated by their disability. Trying not to mind the curiosity of others is
a way for the person to prove that he is not sensitive, that he is not
ashamed, that the disability did not make him maladjusted. Thus, along
with the feeling of being hurt that questioning and staring may produce,
there is a struggle against this feeling. He will, however, restrict the dis-
Grievances and Gratifications 2 1 I
cussion to a superficial level of factual information and to casual feelings.
If the conversation is carried on with an understanding person, the ex-
perience, especially in its cumulative effects through repeated occurrences,
may make it possible for the person to discover that talking about his dis-
ability was not nearly as difficult as he had thought. In this way, even a
superficial level of discussion may provide an opening wedge for change in
the meaning of disability.
There are indications that the person has a desire to be understood,
that he needs and wants to talk about his disability with persons with
whom he feels secure and in situations that enhance his security. He
wants to talk because basically he wants to be accepted as he really is,
with his actual needs and feelings, and not as he appears to be on the
surface. He may also feel a need for reassurance that he is worthy as a
person or that his attitudes and behavior toward others are justified. He
may feel a need to recognize more clearly how the disability has affected
his life and how he can manage more satisfactorily. However, it may be
extremely difficult for him to give expression to this need, for at the same
time he may be weighed down by the overpowering wish to be non-
disabled and to be treated as such. Moreover, those around him may also
feel uncomfortable and embarrassed in regard to the disability. There is
thus a pretense on both sides; both try to act as though the disability did
not exist.
This pretense causes an emotional strain, both in the person with the
disability and in his associates. An estrangement between himself and
persons who matter to him may eventuate, for when feelings are not
shared, when much is not said but is guessed at and misinterpreted, the
distance grows and the relationship suffers. Equally disturbing in the
persistent "as if" behavior is the feeling that the person with a disability
is only seemingly accepted — i.e., that he is not really accepted at all.
Realization of the impracticability of ignoring the disability and of the
negative consequences of attempting to do so removes a large barrier to
communicating about the disability.
The conditions that underlie the person's evaluation of curiosity and
talking about his disability affect, of course, the manner in which he
actually meets the reality of such communication. It is the management
that guides the social interaction and therefore may serve to reduce or
augment interpersonal tensions.
Management by the Recipient
A person with a disability, meeting time and again the questioning and
staring of others, gradually develops ways of coping with such situations.
His manner of approach will partly depend on his general evaluation of
212 Physical Disability — A Psychological Approach
the situation and partly on the social skills he has developed in the course
of trying out different techniques. Some tactics appear satisfying; he feels
comfortable in their use and they seem to be effective in their results.
Other tactics leave him disturbed; he continues to brood about the incident
and to chastise himself for his awkward management of it. The following
scenes, demonstrating commonly used coping techniques, have been taken
in most cases from autobiographical accounts. They have been grouped
according to three general evaluations of the situation in which the other
person is felt to be an intruder. In the first, attacking the offender, the
person with the disability regards the intruder as a fatuous boor and wants
above all to retaliate, if necessary by utilizing his disability in the attack.
In the second, excluding the disability from the situation, the recipient is
dominated by an imperative need to eradicate the disability as a socially
real fact. And in the third, minimizing the disability and preserving the
relationship, the recipient wishes to maintain at a congenial level the
course of communication about the disability as well as the social rela-
tionship. There are other psychological situations and ways of handling
them, but these will suffice to give an appreciation of ways of coping with
the situation and their effectiveness in social situations with some potential
threat.
ATTACKING THE OFFENDER. The agent, usually a stranger, is
seen as being idly or morbidly curious and therefore really interested not
in the recipient personally but only in his disability. Sometimes the re-
cipient senses (correctly or not) that the agent pries in the hope of savor-
ing a lurid tale and thereby aggrandizing himself at the expense of the
recipient. In any event, the reaction to the intruder is a deeply negative
one; the recipient regards him with derision or hatred and wishes to
retaliate in a cutting manner that will make the agent appear fooUsh. This
is accomplished with the techniques, deftly maneuvered, of biting sarcasm
and dramatic prevarication.
Biting Sarcasm. Louise is a young college graduate who lost a leg
in childhood and uses crutches to get about. She recalls the following
interchange inaugurated by a "snoopy old biddy":
"My poor girl, I see you've lost your leg."
That's the opportunity for the louche, "How careless of me!" [Baker,
1946:91].^
Friends, too, can "ask for it." In the following sample, the recipient is
the mother of Noreen, a young lady convalescing from polio:
1 Reprinted by permission from Out on a Limb by Louise Baker, published
by McGraw-Hill Book Company. Copyright 1946 by Louise Baker.
Grievances and Gratifications 213
One day one of mother's friends telephoned to inquire about me.
"How is she?" he asked.
"Why, she is just fine," Mother said. "She is getting stronger, and we think
she will be coming home soon [from the hospital]."
"Yes," he insisted, "but how is she? I mean is she really all right?"
"Why, of course." Mother said. "She will be just fine!"
"You don't understand me," he urged. "I mean, well, has she slipped a little?
Does she think clearly? Does she remember everything?"
"Oh!" my mother said, and when she recovered, "Oh no — she has dreams!
And she doesn't remember everything either, she can't remember where she put
her red printed scarf that she wore last summer!" [Linduska, 1947:IS9].^
Dr.\matic Prevarication. This plan of attack is also exploited by
Louise, above. Eventually she became quite cavalier about satisfying the
curiosity of intruders by imaginatively exciting tales, as the following:
One of my choicest little epics was the heroic account of a swooping venture
on skis. Down a precipitous mountainside I slalomed, a sick baby in my arms,
only to collapse at the doctor's door, the infant saved, but my poor right leg
frozen stifif as a poker. It was so completely refrigerated, in fact, that the
doctor, without administering so much as a whiflf of anesthetic, chipped it off
with an ice pick.
Even unrehearsed repartee came easily. The flapping-eared recipient of the
latter fancy cheerfully swallowed the hook, and was all agape for the line and
sinker. How did it happen that my left leg was so providentially spared, she
wanted to know, not satisfied with what I already regarded as a very generous
slice of my imagination.
"Well, I've been educated about weather," I said. "Me, I'm a Norska from
Oslo. I was smart enough to anticipate chilblains. I decided I'd preserve at
least one leg. Owed it to myself, I figured. I skied on only one foot, after
pinning up my spare in a blanket."
"Well, I do declare!" The hypnotized listener didn't bat an eyelash [Baker,
1946:91-93,1
EXCLUDING THE DISABILITY FROM THE SITUATION. In
this psychological situation, the person vv^ants above all to avoid reference
to the disability. He may resent the intruder, but he cuts him short — not
by attacking, but by excluding the disability from the situation. This is
accomplished by what we have called the ostrich reaction and redirecting
the interaction course.
Ostrich Reaction. The most direct expression of the need to exclude
the disability is to escape from the situation. Such literal behavior is more
characteristic of children; not infrequently the child runs out of the room
2 Noreen Linduska, My Polio Past, copyright 1947 by Noreen Linduska. Used
by permission of the publishers, Farrar, Straus and Cudahy, Inc.
214 Physical Disability — A Psychological Approach
or buries his face in the mother's lap. Henry Viscardi, dwarfed through
congenital deformity of his legs, offers the following example:
. . . My mother took me home on a street car. It was open on the sides and
had high steps. She had to lift me up onto the straw seat, then she got in. I sat
with my boots straight out in front of me but they did not reach the edge of
the seat. Across the aisle a woman in an orange coat nudged the woman next
to her and pointed at me. I held my mother's hand tight. Then I saw that
everybody on the street car was looking. My mother put her arm around me
and I hid my face next to her coat. I wanted to run away from all those
people [Viscardi, 1952:10].^
This direct blocking out of the disagreeable is less readily open to an
adult. It appears too childish and exposes too blatantly the personal hurt
that an adult generally also wishes to keep private. The adult's efforts to
escape the situation, therefore, take more subtle form.
He may return an icy stare that freezes the atmosphere. Viscardi, as a
college student less than four feet tall, describes his more adult manage-
ment of staring, staring that he encountered day after day after day:
There were the thick-skinned ones, who stared like hill people come down to
see a traveling show. There were the paper-peekers, the furtive kind who would
withdraw blushing if you caught them at it. There were the pitying ones, whose
tongue clickings could almost be heard after they had passed you. But even
worse, there were the chatterers, whose every remark might as well have been
"How do you do, poor boy?" They said it with their eyes and their manners
and their tone of voice.
I had a standard defense — a cold stare. Thus anesthetized against my fellow
man, I could contend with the basic problem — getting in and out of the subway
alive [Viscardi, 7952.70].
The person with a disability may lower his eyes and look past the
intruder and hate the source of his anguish. Goldman, lame from polio,
recalls an incident in his adolescence:
I stand in the doorway to a restaurant, as yet unnoticed, my heart sinking,
my body filling with a great tumor of anguish. The sensation is akin to both
swelling and shrinking. I wish that I would shrivel away to nothing, Uke a
paper curling to ashes in the grate, or that I would burst with the swelling.
People! Eyes! Eyes!
Something in the back of my mind moans, O God, O God, O God! I lash
my courage: Enter! Get it done and over with! What the hell? What's the dif-
3 Henry Viscardi, Jr., A Man's Stature. Copyright, 1952, by Henry Viscardi,
Jr. Used with permission of The John Day Company.
Grievances and Gratifications 215
ference? The hell with 'em! I want to be bitter, get mad, put the blame on them
— those people sitting there with eyes. I want to hate them so that I won't care
what they think.
I press my teeth together. I clench my fists. Every muscle of my body
tightens and I enter with my head up. I walk down the aisle between the rows
of tables, looking neither to left nor right.
But you need not see eyes; you can feel them. Even when you know that you
are past them and they are behind you, they reach out with something that
touches you.
The aisle is miles and miles in length but at last I reach my table and seat
myself. I relax. There is a light dew of sweat on my fact. I'll be all right in a
minute. The tablecloth is long, my legs are under the table. Now to order, eat,
and enjoy a hard-earned meal. I don't want to look too far ahead. After a
while I must get up and walk out again [Goldman, 1947:65-66^.*
Redirecting the Interaction Course. One can sometimes escape
the unpleasantly intrusive question by stopping it before it is uttered and
then taking control of the conversation. Louise, with one leg amputated,
was a frequent target of the curiosity of others. She developed a manner
that said in effect, "I know what you're thinking, but keep it there" [Baker,
1946:911
And when an intruder has already made some headway, the recipient
is sometimes able to collect himself suflBciently to ignore it with a matter-
of-fact, otherwise empty comment that reveals nothing of the self but
serves to rechannel the interaction to nondisturbing areas. This is seen
in the following interchange between Frances, a college girl with impaired
hearing who is frightened of deafness, and Victorine, a casual acquaint-
ance:
"Why don't you try a chiropractor?" she [Victorine] asked me, chewing
corned beef, giving no slightest indication that she was about to knock the
bottom out of my world. "Dr. Fletcher told me he's curing one of his patients
of deafness."
My heart skittered, in panic, against my ribs. What did she mean?
"My dad's deaf," she revealed. "I can spot a deaf person anywhere. That
soft voice of yours. And that trick of letting your sentences trail off — not
finishing them. Dad does that all the time."
The bottom fell out of my world. What was she saying? That she spotted
me for a deaf person? That it was perfectly plain to anyone that I didn't hear
weU? That wasn't so. It couldn't be so. Nobody could possibly guess I didn't
hear well; I had everybody bluffed. Besides, I could hear all right. Nobody
could call me a deaf person. Nobody with long spindle legs and a bad com-
plexion and fuzzy yellow hair that looked as if she never brushed it.
* Selection from Raymond Goldman: Even the Night. Copyright 1947, The
Macmillan Company, and used with the permission of the publisher.
216 Physical Disability — A Psychological Approach
My head spun with fury. Did I trail my sentences? I did, often. Often I'd
see, from the expression on another person's face, that I was talking on the
wrong track, that I'd misheard something. . . .
"Dad's wonderful," Victorine was saying. "He can't hear thunder without an
earphone and not very much even with an earphone, but he keeps trying. He's
got our dining-room table and his favorite chair in the hving-room all wired
up for sound; you can't move without tripping over electric wires and storage
batteries. Just lately one of the hearing-aid companies came out with a portable
model that he can carry around in a black box. It weighs . . . [Victorine
continued to ramble on in this fashion, obhvious of the panic she had created.
Finally, Frances, with a forced indifference, interrupts.]
"Really? We'd better be getting back for the Math exam," I said freezingly
[Warfield, 1948:44-A5].^
MINIMIZING THE DISABILITY AND PRESERVING THE RELA-
TIONSHIP. There is also the situation in which the recipient accepts
his disability as a social fact but wishes to moderate the intensity of
involvement with it. Instead of a serious concern centering around his
disability, he wishes to keep the discussion at a superficial level. At the
same time, not feeling any ill will toward the intruder, he desires to
maintain a congenial relationship. This may be accomplished through the
techniques of good-natured levity and superficial discourse.
Good-Natured Levity. Some persons build up a repertoire of light
remarks that they can use in appropriate settings. Russell (1949) found
that strangers more quickly took him and his hooks for granted after some
such icebreaker. He might make a crack about how the one thing he
could not do with his hooks was to pick up a check at a restaurant, for
example. In providing a light touch, such remarks set the social climate.
They say, in effect, "I am not disturbed by my disability. So you may
feel comfortable about it too, and we can go on to other things from
here."
Superficial Discourse. The following conversation is between two
young teen-agers, Criddle who recently lost his sight in a childhood
accident, and Red, his friend:
"What's it like to be blind?" Red asked.
"How do I know?" I said, still irritated by the word. "I ain't blind. I just got
bad eyes, that's all."
"TTiat's what I mean," he placated. "What's it like?"
"It ain't like nothing. You just can't see, that's all."
"Does it hurt?"
"Nah, you bump your shins sometimes, and that hurts, that's all,"
"Is everything dark?"
5 F. Warfield, Cotton in My Ears, New York. Viking Press, Inc. Copyright
1948 by Frances Warfield. Used with permission of Viking Press, Inc.
Grievances and Gra+ificafions 217
Knowing Red was fascinated by my blindness, I exploited the opportunity,
and drew on what mother had said: "It's like looking through a frosted glass,
like we have in our bathroom only not so frosted. Your ears, smell, and touch
make up for your eyes."
"You mean you can see with your ears?"
"No, of course not. You just hear better, that's all."
"And smell better?"
"Sure" [Criddle, 1953:25-26].^
Criddle avoided talking about the deeper and more personal meanings
of blindness by brushing off any insinuation that he is seriously handi-
capped. He effectively guided the conversation to moderate inconveniences
and at the same time maintained a comfortable relationship with his
friend.
SITUATIONS NOT REQUIRING SOCIAL TACTICS. Thus far we
have analyzed situations in which the questioner is felt to intrude, actually
or potentially, into the privacy of the recipient. Some communication
about the disability, however, does not threaten privacy. Sometimes the
attitude toward the disability is so matter-of-fact on both sides that the
discussion can arise very naturally. This occurred during Karen's first day
at kindergarten. Around the sandbox, Lucy, a schoolmate, asked Karen if
her braces were broken at her knees. "Karen explained that her braces
had joints where her legs had joints so she could move right, and then
added very matter-of-factly, T have cerebral palsy, you know. I'm a
spastic. Are you hungry? I am' " (Killilea, 1952:114-). ~
Also, as discussed earlier (p. 211), there are times when the person
needs and wishes to talk about his disability. Sometimes the person him-
self may introduce the topic to someone close to him, to a therapist, or,
more rarely, to a stranger. Sometimes it is the situation that brings up the
disability. When the person wishes to talk and his listener is sympathetic
and understanding, discussion about the disability may continue without
special maneuvering on the part of the recipient. Russell Criddle offers
an example of this. He had been in a "fight to the death" at his high
school with Mike, a boy who had been taunting him relentlessly about his
blindness (see pp. 245-246 for incident). The next day, certain that he
would be expelled, Criddle was called into the principal's office. At first
he was sullen and would not participate in the conversation. Then the
principal said something that struck a sympathetic chord and Criddle
poured out what had long been kept within him. The principal said:
^ Reprinted from Love Is Not Blind by Russell Criddle by permission of W,
W. Norton & Company, Inc. Copyright 1953 by Russell Criddle.
' Reprinted with permission of Prentice-Hall, Inc., from Karen by Marie
Killilea. Copyright 1952 by Marie Lyons Killilea.
218 Physical Disability — A Psychological Approach
. . . "You have a good head, Russell, and you must learn to keep it. People
like Mike and me can aflford to lose theirs once in a while, but a man that is
blind needs to keep his. Society will not tolerate normality from you; you will
either have to be nearly perfect or completely bad."
"I know," I said. "I expected to be expelled."
He seemed surprised at this. There was real curiosity in his voice as he
asked, "You did? Why?"
"People pity me," I answered, "and it hurts them. They want me to go away
all the time. They're afraid of blindness," I went on, "and they think I feel
afraid all the time, like they think they would be if they were like me. It's
because they think I'm scared that they think I'm dumb. People are always
dumb when they are scared, that's why people can't use their intelligence when
they think about me, and want to help me. They're scared of bUndness. That's
why Mike kept hurting me, because he was afraid of me. People, most of them,
hurt people they are afraid of" [Criddle: 7955 .-104].
And the conversation that continued was good and full and central.
Social tactics had no place, for in this situation Criddle had nothing to
guard.
THE SPECIAL PROBLEM OF CURIOSITY IN CHILDREN. Many
social forms have emerged because they permit or even give rise to con-
genial interpersonal relationships. Children have to learn these social
expressions of politeness and to regard them as logical, or natural, or
helpful toward comfortable relationships among people. For example, the
adult ordinarily greets a visitor. A child, however, may just as naturally
merely glance at the guest and turn away to his immediate interests with
nary a gesture of recognition or welcome. To the adult this behavior may
appear so incongruous that it seems amusing, or it may be taken as down-
right rudeness or a sign of poor breeding. In any case, the child has to
learn that greeting a visitor is the usual way of making him feel welcome.
Similarly, there are social forms that regulate the manner of satisfying
one's curiosity. Although, as we have seen, adults often overstep accepted
propriety, children, albeit unwittingly, probably do so more frequently and
more flagrantly. It is only gradually that they learn to refrain from asking
a stranger directly and openly about his disability, to wait until a person
is out of earshot before asking the mother questions about him, to keep
from staring and pointing, etc.
To some persons the frank curiosity of children is not markedly dis-
turbing. They feel that it is a natural expression of interest, void of malice,
and therefore it should be responded to in a matter-of-fact and friendly
way even though one may not have chosen to engage in the transaction.
The story is told of an elderly woman whose chin trembled. When asked
by a small child why her chin went up and down like that she simply
replied, "Well, vou know, I have something that makes my chin go like
Grievances and Gratifications 219
that." The child looked some more and then passed on to other things
(Dembo, Leviton, Wright, 1956:50). To other persons, children remain
a constant threat. If the person believes or tries to believe that his dis-
ability is not very noticeable, it is all the more upsetting when a child
innocently calls attention to it. Not only do young children barge in, but
they are so preoccupied with their own curiosity that they can remain
insensitive to the other person's reaction. Even though the recipient may
appreciate that the curiosity of the child is natural, he may at the same
time feel confused, embarrassed, and resentful.
It is well for the individual who inevitably will face the curiosity of
children to think over how to meet it. In thinking it over, in talking with
others about their reactions, he may become aware that his own feelings
about his disability and how he regards himself are really among the more
important factors in his general reaction (see Chap. 7).
INDICATED RESEARCH. Clearly, further research is needed to
determine which of the variety of techniques discussed above are most
appropriate to particular situations and to the needs of the recipient.
Although there is no systematic research on this question, an investigation
by Citron, Chein, and Harding (1950) of a related problem exemplifies
one fruitful approach to problems of management of social tensions in
general. The study dealt with the handling of antiminority prejudice
through appropriate counteracting retorts. In setting up the experiment,
the investigators decided that :
The study would concentrate on the behavior of the answerer rather than on
the behavior of the bigot or the object of the bigot's attack.
An ideal answer should meet the following criteria: Its effect on the bigot
should be to dissuade him from expressing his prejudice in public. It should
raise the personal morale of the minority group member and of the answerer.
It should minimize in the bystanders any increase in prejudice that might have
resulted from the bigot's remarks, and should encourage potential answerers in
the audience to become actual answerers in the future. Because of practical
considerations, an answer must be made in a few words, simply expressed,
suitable for a variety of incidents, and not demanding histrionic skill.
During the exploratory phases of the research, many types of answers that
appeared promising with respect to the criteria above were tried out in a num-
ber of different situations. Two answers were selected for experimental study.
These were the American Tradition argument, which stressed such values as
fair play and the fact that this nation was built by all races and creeds, and
the Individual Differences argument, which stressed that one should not
generalize from one or two cases. In the main experiment, each answer was
presented half the time with high emotion and half the time in a calm manner.
This yielded four tj^es of counterargument.
The incident selected for the experiment involved a public situation in which
one of the characters in the scene managed unintentionally to offend one of the
220 Physical Disability — A Psychological Approach
other characters, who in turn insulted the ethnic group to which the first person
belonged. A bystander challenges this.
The incident was presented to the subjects as a dramatic skit. The script for
the incident with the American Tradition counterargument follows:
The scene is an employment bureau in which several men are seated waiting
to be interviewed, some filling out appUcation forms, some smoking and
chatting:
Secretary: "Who is next?"
(Two men stand up and exclaim simultaneously.)
Goldstein and Jones: "I am."
Secretary: "Well, I don't know for sure who is next. It's hard to tell with
so many fellows coming and going. Suppose this gentleman (pointing)
comes in now, and another interviewer will be ready for you in a minute.
May I have your name, please?"
Goldstein: "My name is Harry Goldstein."
Secretary: "This way, please, Mr. Goldstein."
(Goldstein exits with secretary. The other man turns to resume his seat
and exclaims disgustedly so that the others cannot help hearing him.)
Jones: "He was not next! Goldstein, huh? Another Jew who can't wait his
turn. These Jews are all alike. Who do they think they are anyway?"
(Mutters.)
American Tradition counterargument:
Bystander: "Take it easy, fellow. I wouldn't say that if I were you. We
don't want that kind of talk in America."
Jones: "Ah-h . . . these Jews are always trying to get away with some-
thing. Pushing ahead. . . ."
Bystander: "That's no way to talk. What kind of country would we have
if we didn't stick together? We'd be easy suckers for someone to make
trouble."
Jones: "What business is it of yours?"
Bystander: "I'm telling you it's unfair to pick on the Jews, or any other
group, for that matter. Everybody in America should get the same square
deal."
Jones: "Why are you so worried about the Jews?"
Bystander: "It's not just the Jews I'm worried about. It's the danger of
that kind of talk to our democracy that worries me. This country is made
up of all races and religions and it's up to us to see to it that they all get
an even break."
(Secretary returns and speaks to Jones.)
Secretary: "It's your turn now — may I have your name?"
Jones: "My name is Jones, Edward Jones."
Secretary: "All right, Mr. Jones. Please follow me."
(Exit Secretary and Jones.)
Attitudes toward Jews measured after the play were compared with those
expressed on the same questionnaire previous to the counterarguments.
Of the four types of answers presented in the dramatic skits two showed
Grievances and Gratifications 221
a significant net reduction in prejudice. These two were the American
Tradition argument made in a cahn, quiet manner, and the Individual
Differences argument made in an excited, militant manner. Because
audiences prefer a calm handling of the situation, the investigators
recommend the former.
Note that the investigators had first to decide on the criteria for an
ideal answer before they could select possible answers for experimenta-
tion and tests for their effectiveness. Likewise, in curiosity research one
would have to make exphcit what the recipient might strive to accomplish
in a given interaction and the different techniques whereby this might be
realized. Thus, as we have indicated, if the recipient is mainly geared to
punish the intruder, certain behaviors will make sense; if he wishes above
all to exclude the disability, other behavior will be more effective; if his
main goal is to preserve the relationship another approach may be indi-
cated; and if he wishes to affect positively the attitudes toward disability
in the other person, still other means may be in order. Thus it is clear that
social skills become the practical expression of the meaning of a social
relationship as determined by events in the environment and events within
the person.
Recommendations
To avoid being hurt by the other person and to make communication
possible when desired, the subjects of the Dembo study gave recommenda-
tions to the nondisabled. In different ways they expressed the following
rules (White, Wright, Dembo, 1948) :
1. Don't talk about it unless the person with the disability brings it up.
2. Don't talk about it unless he wants to.
3. Don't ask questions immediately.
4. Take into account the mood of the person.
5. Don't dwell on it.
6. Don't try to get him away from the subject.
A principle underlying these recommendations is that the person with a
disability should determine when and how the discussion should start and
the course it should take. However, the clues by which the nondisabled
person may be guided are rarely clear-cut and definite. They are often
subtle, elusive, and may even be covered up. When the communication is
an outgrowth of a definite situational or personal context, the other person
is better able to interpret the clues correctly, since the broader context
helps to structure their meaning. By refraining from communication about
222 Physical Disability — A Psychological Approach
the injury "until it comes up naturally," therefore, the other person can
be more effectively guided by the wishes of the person with a disability.
The following example is an interesting case in point. It is taken from
the life of Frances Warfield, the young woman with a hearing disability
to whose reminiscences we have frequently referred. It may be recalled
that her hearing impairment meant utter and complete degradation to her
and that she tried at all costs to hide her disability. Finally, after secretly
going from one doctor to another, after trying all the patent cures she
came upon through newspaper and quack, she became resigned to wear-
ing a hearing aid. Life was, she felt, over for her. Almost every facet of
her being had been identified with her hearing disability, and now with the
hearing aid that publicized it. In spite of her complete rejection of her
disability, she was able, in the following episode, for the first time to men-
tion her hearing loss, however falteringly, because it came up naturally
with a person close to her — Phil, her suitor discovered the aid while
rumpling her hair. Notice, too, that the topic is not dwelt on and that
Frances in large part channels the direction it takes.
When Phil came to take me to dinner that evening I was dead.
He rumpled my hair, as he always did. Then — "What have we here, Junior?"
"A gimmick," I told him. This was the end. He'd send me away now. "You
wear it under your hair," I said. Then you don't need to be deaf . . . You
don't need to be deaf . . . You just need to be dead. . . .
He nodded at me approvingly. "Good girl. I've been wondering if you
wouldn't get one of those, one of these days."
"You know that I'm hard of hearing?"
"Everybody who knows you knows that, Junior."
"Well, I'll be a sonofabitch!"
"And nobody gives a damn" [Warfield, 1948:\5Y].
We have drawn upon this example to show that adjustive communica-
tion about the disability is more effectively cued when the context of
situation and personal relationships between agent and recipient are taken
into account. The suitor, although not observing Rule 1 (i.e., Frances
did not bring up the subject of her disability), recognized her covert
desire to talk about it (Rule No. 2). Actually, one of the basic conflicts
in a person with a disability — the conflict between wanting to be like a
nondisabled person and wanting to accept himself with his disability —
permits a person who is close to bring up the disability in a natural setting.
Because of this conflict, the person with a disability may and may not
wish to talk about his disability at the same time. Even a brief allusion
to the disability may then have far-reaching positive effects, for the mere
fact that it is brought up in an open, matter-of-fact way by a trusted
Grievances and Gratifications 223
friend may in itself help. One is silent or whispers about the terrible, but
the mentionable has met the first criterion of the acceptable.
The problem of curiosity would be greatly eased if the nondisabled
were familiar with such interesting aspects of disability as prosthetic
devices and how they work, new ways to meet old situations, and success
in spite of or because of a disability. Public education can well utilize the
imaginative thinking and effort of those working in the field of rehabilita-
tion. A report by Rusk and Taylor {1946) offers an example of meeting
the problem of curiosity through public education:
. . . when one of the authors was invited to speak to a group of eighth
graders, ... he took with him a number of prosthetic devices, crutches,
artificial eyes, dentures, hooks, legs and hearing aids. Following a group
session in which noted personalities who had severe disabilities were discussed,
each of the devices was explained, and the children were invited to use them.
They walked around the room on the crutches, put on the hearing aids, and
tried to hold the artificial eyes in their eyes as though they were monocles. Two
fourteen-year-olders got one of the artificial hands, and while one held it
steady, the ether tried to manipulate it to pick up objects like the bucket grab
bags do at Coney Island. They had not only an instructive but an enjoyable
time. Their inquisitiveness was brought out in the open and satisfied, rather
than being fettered to the point that it might eventually become morbid
curiosity [pp. 222-223].8
Information concerning the coping aspects of disability (see pp. 59-
70) through knowledge of prosthetic devices, of persons with dis-
abilities who have succeeded, of the fact that a disability is just one part
of a person's life, does more than abate curiosity. It fosters that kind of
understanding which will not only improve relations between those with
disabilities and those without but will serve the latter well for the eventu-
ality of needing to accept a disability on their own behalf.
THE PROBLEM OF HELP
The adult able-bodied person hardly gives a thought to the problem of
help because it is not a problem to him. Help is a good thing; it expresses
concern for another, a willingness to put oneself out for his well-being,
all of which is sanctioned in our system of values as essential to the growth
of man as a social being. Yet help may not simply be taken for granted
by a person with a disability, for it connotes a variety of meanings and
experiences, some of which threaten him. In the Dembo study, the sub-
8 H. A. Rusk and E. J. Taylor, New Hope for the Handicapped. Harper &
Brothers, 1946. By permission.
224 Physical Disability — A Psychological Approach
jects with disabilities evaluated help (bodily assistance) both positively
and negatively but emphasized the negative (Ladieu, Hanfmann, Dembo,
1947). Half of the subjects had more bad things than good things to say
about being helped, whereas in only about one fourth of the subjects was
this relationship reversed.
Help as a Social Relationship
The act of helping may be disturbing to the recipient because it is not
simply an act that may be more or less useful to him; it is primarily a
social relationship that expresses a variety of attitudes on the part of the
participants. As the study of the evaluation of help has stressed, the act
of helping represents a one-sided social relationship that easily leads to
status judgments. The person who is always the one to be helped is likely
to be considered as inferior.
Disparaging aspects of receiving help have a variety of contents. Some-
times the proffered help is interpreted by a person with a disability as
meaning that he is considered more helpless than he actually is, and
therefore not only is the help unnecessary but it also questions his status.
Sometimes the help is felt to be motivated by hypocritical self-aggrandize-
ment; the helper, being intent on inflating his own ego, is completely
insensitive to the wishes of the recipient. Sometimes the act of helping is
resented because it calls attention to the person's disability or is felt to
set him apart against his wishes. Underlying this unwillingness to be
noticed is the fear of being devaluated as a disabled person. Not only
does he feel that his social standing is jeopardized, but also his defenses
against feelings of self-devaluation become threatened. Sometimes the
help is seen as oozing pity, in which event it is generally rejected with
bitter condemnation.
At the same time, the subjects in the help study did recognize the pos-
sible positive intentions of the helper. But what seems more striking is the
fact that such approval was generally half-hearted and qualified with
precautions against implications of inequality or threats to one's independ-
ence. It must, of course, be recognized that the subjects of the help study,
being men, might be expected to see in help evidence of personal in-
feriority and threat to independence more strongly than women. Whereas
helping a man might be taken as a threat to his manliness, helping a
woman is not as likely to endanger her sex role.
Help as an Expediting Act
Aside from social implications, the act of helping can either advance
the recipient toward his desired goals or actually impede his progress.
Grievances and Gratifications 225
Unfortunately, even when a well-intentioned helper perceives the goal of
the recipient correctly, he is not always able to help effectively. He may
lack the necessary understanding of what the disability entails or the
techniques of help that would be appropriate. The subjects in the help
study registered an emphatic protest against what almost constitutes an
unexpected attack by an awkward person who eagerly tries to help but
succeeds only in getting in the way. "Help" of this kind menaces the
physical security of the recipient, which may already be shaky.
The objection to help, however, is not limited to useless or interfering
acts. Many of the subjects also objected because of an indomitable need
for independence. Although assistance may expedite the achieving of an
immediate goal, the long-range goal of learning-to-do-for-oneself is
blocked. These subjects protested against being babied and spoke of the
fear of becoming a burden and of being spoiled. Accepting help may lead
to an anticipation of helplessness in the future, which creates uncertainty
and fear. Rejecting help in order to learn to do things for oneself not
only increases one's independence but also enhances feelings of personal
worth.
Thus, with regard to expediting matters, many of the subjects restricted
acceptance of help to necessary help; but because of the manifold mean-
ings of help already pointed out, the concept of necessity tends to be more
stringent than is commonly conceived. The degree of inconvenience
tolerated by a person with a disability before he considers help necessary
often far exceeds that ordinarily tolerated by a nondisabled person. The
subjects in the help study tended to use the term "necessary help" in the
strict sense of absolute necessity, i.e., without which a goal is excluded no
matter how much effort one is willing to expend. Even then, the findings
show, concern about help is due less to the question of its necessity than
to the strong fear of social inferiority and dependency connoted by it.
This is not to say that help is never exploited. There is ample clinical
evidence to show that certain individuals revel in their disability, demand-
ing all kinds of unnecessary help, as a way of ruling the roost or satisfying
their need for dependency or perversely reassuring themselves that they
are loved. That these motivations for accepting help do not appear in the
help study is not surprising, for they are personally unfavorable and tend
to be kept private if not suppressed from consciousness.
Management by the Recipient
As in the case of curiosity, the recipient, for better or for worse, reacts
in some way to situations involving help. In order to become more inti-
mately in touch with the different meanings of being helped as well as to
226 Physical Disability — A Psychological Approach
observe how the recipient does react and cope, we shall examine several
scenes from real life experiences as reported in autobiographical accounts.
Henry, a young boy with dwarfed and deformed lower limbs, goes
swimming with the neighborhood boys. The help he receives is so natural
and situation-rooted that it is just as naturally accepted:
. . . one day some of the big boys came by and called up to ask Mamma if
I could go for a walk — over by the river. Mamma finally said yes, but be
careful.
I walked part of the way, and when I got tired they hoisted me up on their
shoulders. Then I really was tall — taller than seven feet. We came to the
railroad tracks. I had never been this far from home except with Mamma or
Papa, and it was exciting.
"Look at that old cardboard," Marble Bags [the champion marbles player]
said. It was a big piece. It must have been wrapped around a mattress or
something.
"Let's build a shelter."
An empty freight car stood on a track and the boys put the cardboard under
it and bent it like the sides of a house. Then we all crawled inside and they talked
about baseball and girls. It started to rain, so we stayed. It was just hke being
in a clubhouse. One of the boys took out a cigarette butt and lit it.
"Give me a puff," somebody said.
"Look, the sun's out. Let's go swimming." Marble Bags ran across the tracks
and down to the river where he peeled off his pants and shirt and dived off a
big rock.
The other boys picked me up, and we ran after him.
I sat on the bank and watched them paddle around.
"Come on in," they yelled. "We'll hold you up."
Did I dare? Of course, they said. Hesitantly I took off all my clothes except
my boots, and two of them let me down over the side of the rock.
"It's cold," I shrieked. But as soon as I had been in the water a minute it
felt wonderful. I paddled with my short legs while they held onto my hands.
"I can swim! I can swim — almost," I gasped [Viscardi, 7952.32-33].
However, the help situation is not always so comfortable. Sometimes
it is hated but the recipient feels powerless to do anything but "grin and
bear it." The following is an instance of boorish, self-aggrandizing help.
Henry Viscardi, now a young man, is again the recipient:
The train disgorged a mass of us at a midtown station, and I glanced again
at the address of the employment agency I would "visit" today, trying to
memorize the address. ... A dried-up-looking man came by and took my
arm. Despite my unresponsiveness, he drew me up a flight of stairs and all the
way out of the station where he deposited me with a sanctimonious smile on
the wrong side of the street.
Grievances and Gratifications 227
Mother of God, I thought, I bet he's the kind who goes to church and prays
for those poor helpless cripples [Viscardi, 1952:71].
In the following scene, Harold Russell, whose injury caused the loss of
both hands, has no alternative but to submit. Though the help was neces-
sary, it was unrelenting torture and continued to be as he mused over it.
His pride is hurt deeply, for the help stirred again the desperate doubts
about his manliness. The airline hostess has just instructed the passengers
to unfasten their safety belts:
I started to pull my hooks out of my pockets, but they got stuck, I wrestled
with them for a few seconds and finally I got them out after nearly ripping off
my pants. Then I began fumbling with the belt. She had offered to close it
before we took off, but I declined stiffly. Now she stood over me like a school-
teacher, watching me struggle with it. I just couldn't seem to get a grip on that
slippery metal buckle. I could almost hear her saying, "See! What did I tell
you? You can't do it by yourself." That only made me more nervous. Finally
she reached down, flipped it open and walked off triumphantly into the cockpit.
I fell back against the seat. This was the ultimate humiliation. Only a few
months before I had been the rough, tough paratrooper, boldly leaping out into
the wild blue yonder. Now I had sunk so low I couldn't even open a simple
safety belt without the help of a woman. I thought of what the boys in my old
outfit would have said to that. I could hear them laughing [Russell, 1949:12S].
Though help may be humiliating, the recipient gradually learns how to
make it more palatable in situations in which he cannot do without it.
Russell Criddle, for example, while still a teen-ager, attempted to confine
help to situations in which it was absolutely needed because of his poor
vision; he then took the initiative as to where and how it should take
place. The boys are planning a swimming outing down the river:
Someone grabbed my arm.
"Go get your suit, Russ. I'll lead you, and if anybody says you're blind, I'll
push his face in."
It was Bud [leader of the gang]. He had humbled himself to such a degree
just so I could go swimming. But I pictured him leading me, with the gang
looking on in anguished pity, and the thought was intolerable.
"You won't have to lead me," I said. "Just let me put my hand on your arm
down by the dump and across the tracks" [Criddle, 1953:2S].
Criddle also developed the policy of letting the most distinguished
person in the group lead him through difficult places:
I found that it didn't seem to embarrass them so much as it did others, and
it was easier for me to accept condescension from someone whom I admitted to
be my superior [p. 42].
228 Physical Disability — A Psychological Approach
When help is not felt to be necessary, the reaction depends largely on
whether the recipient is indignant or not. If an insult is presumed, it is
met by an unfriendly counteraction. On that first furlough home after his
injury, Harold Russell recalls:
Fred [a sailor friend] was uncomfortable, too. We didn't know how to greet
each other. Somehow, it seemed gruesome to extend my hook, so we just
nodded stiffly and said hello. Then he reached out to take my bag, but I
yanked it away quickly. I didn't need his help [Russell, 79-^9.130-131].
If no offense is presumed the person is able to reject or accept the help
in a matter-of-fact or good-natured way. In the following instance the
help is naturally declined. Mr. Wilke, born without arms, visited the
Bruckner family, whose child was similarly disabled. Mrs. Bruckner
relates :
It was almost eight o'clock when he arrived. My first reaction was sheer
amazement at the size of the suitcase that he had strapped to his shoulders.
Hy tried to help him remove it, but he quickly said, "Thank you, I am able
to manage it by myself" [Bruckner, 1954:175].^
Gracious acceptance of unnecessary help also becomes possible. Louise
Baker, a young woman leg amputee, became convinced that this was by
far the most agreeable reaction in most situations:
Excess generosity is one of the problems a handicapped person faces. I have
found that I am more likely to err in refusing than accepting. Seats offered me
in crowded cars; special consideration in the queue at a theater; porters rush-
ing through trains to open doors for me; shoppers giving me their turn at a busy
counter in a store — and even cameos, presented by strangers. They all pose a
problem.
A handicapped person doesn't win any of these on his merit, and frequently
he doesn't require any such thoughtfulness. In my childhood and teens, I am
sure I was very rude in my constant huffy refusals of any kind of aid. I have
grown more mellow, more sensible, and, I believe, more kindly.
Frequently I accept proffered places in crowded buses or trolleys, from tired,
elderly men who I know need the seats much more than I. But, according to
faultless authority, "It is more blessed to give than to receive." For the most
part, I am convinced it is up to the handicapped person graciously to let the
giver be blessed [Baker, 79'^6.1 17-118].
The person with a disability is sometimes in the position where he must
ask for help. If receiving help is degrading to him. not only will he wait
9 Leona S. Bruckner, Triumph of Love, New York, Simon and Schuster, Inc.,
1954. By permission.
Grievances and Gratifications 229
until it becomes absolutely necessary but his request will be made bitterly,
or at best apologetically. When, however, the help situation does not
connote any feelings of devaluation, but rather acceptance and good will,
the request for help may come naturally and easily. Wilke, the armless
visitor, sat down to eat. His hostess recalls:
I tried to be casual as I placed his dinner plate on the table, explaining that I
was serving him family style as it was quicker. I was determined not to offer
to help him in any way unless he asked me to. I had thought that it might be
embarrassing to him to have us all gathered around while he ate, but he very
nonchalantly asked us to keep him company. He smiled at me as he said, "Oh,
steak, this is a treat. But I am afraid I will need your assistance with this,
Leona. This is one meat that I can't cut with a fork." I cut his steak into
cubes while he continued talking. "I have a special combination knife and fork
at home [which he uses with his foot], but since I try to travel light, I can't
bring it along and must rely on the kindness of my hostess" [Bruckner, 1954:
176].
The act of helping, as we have seen, can either lead to good will and
firmer interpersonal relations or to ill will, personal hurt, and the dis-
integration of social relationships. What principles can be formulated
whereby the act of helping will produce beneficial rather than negative
results?
Recommenda+ions
The investigators in the help study (Ladieu, Hanfmann, Dembo, 1947)
offer certain practical recommendations suggested by the findings.
The fact that rejection of help is both an expression of status anxieties
and a realistic means for achieving self-reliance leads to two basic recom-
mendations to the helper. First, the helper will be better prepared to meet
the situation adequately if he keeps in mind that a person with a disability
may want to limit his use of help to instances of absolute necessity. This
mind-set should not be difficult to estabhsh inasmuch as there is indication
that the noninjured perceive cripples in general as being persistent and
giving up only after definite proof of impossibility. In one study (Mussen
and Barker, 1944), the subjects rated cripples on 24 character traits; of
these, self-reliance and persistence were rated nearest to their ideal. It
would seem, then, that the effectiveness of this awareness may often be
weakened by the helper's own needs, such as self-aggrandizement and pity,
which lead him to insist on helping when help is not wanted. The helper
must, therefore, become aware of his own feelings and needs so that
these can be kept from obscuring the determination as to whether help
should be offered.
230 Physical Disability — A Psychological Approach
Secondly, the helper can reduce the negative social implications of help
by his own behavior. The subjects in the help study indicated two main
principles for making the act of helping a more comfortable one:
To begin with, they stressed the importance of obtaining the consent
of the person involved. The helper must realize that he is in a relatively
poor position to know just when help is needed, and of what kind. For
one thing, the helper as an outsider does not have knowledge of the
actual behavior limitations and how best to meet them. In fact, the general
tendency to overestimate the degree of disability frequently makes him
see the person as more helpless than he actually is.
Who but the initiated or specifically informed would guess that Wilke,
the armless visitor, could manage very adequately at the table, at personal
grooming, and at being a man around the house? The following scenes
are described by Mrs. Bruckner, the mother of the armless boy, whose
home he was visiting.
At the table:
He pulled oflf his loafer, picked up the fork and started eating. I cannot
describe how easy and graceful his motions were. He did not use his bare feet,
as I had expected, but his left, black silk sock was specially made. It had been
sewn like the first two fingers of a glove. He only needed the big toe, which he
used like a thumb, and the first digit; an unusually large space had developed
between them, like the space between a normal thumb and first finger. He did
ask me to give him a cup instead of a glass, but aside from that he manipulated
everything so easily and neatly that I couldn't help but compare him favorably
with my own often clumsy movements. He selected a piece of bread from the
bread tray and spread it with butter; everyone knows how slippery and difficult
to manage hard butter is. But, unlike many of my able-bodied guests, he
dropped no crumbs on my carpet and spilled no food on my tablecloth. When
he had finished eating, his place at the table was orderly and clean, and I felt
ungainly in comparison to his efficiency [Bruckner, 1954:177],
At personal grooming:
... He bent down and wiggled out of his jacket. Then he picked it up with his
toes and hung it on a hanger more neaUy than my husband has ever been able
to do. He wore suspenders, which he could slip off his shoulders with no
trouble. His shirt had a full-length zipper, concealed in the front, instead of the
usual buttons. . . . since he travels a lot on lecture tours and doesn't want to
carry too much baggage, he wears only nylon or orlon shirts and underwear
and washes them out each night [Bruckner, 1954:179].
At being a man around the house:
He told us that he danced, but didn't care much for it. He owned and
Grievances and Gratifications 231
operated a car and had a regular driver's license. "I do everything that any
other family man attends to around the house," he said. Then he grinned and
looked down at his feet. We were sitting in the hving room and he had not
yet put on his socks. "You can see that I painted the baby's crib last week," he
said. "I love to go around barefoot, and I haven't yet been able to get all the
blue paint off my feet. I do all my own painting and repairing, take care ot
putting up the screens and storm windows and all that sort of thing" [Bruckner,
1954:lSl].
Can you imagine the same settings but differently enacted because a
helper insisted on spoon-feeding Mr. Wilke, on removing his jacket and
his shirt, on stirring the paint and painting the crib for him? Yet such
annoying if not humiliating interference is precisely what occurred when
the man escorted Viscardi across the street (see pp. 226-227) and is
repeated countless times in the lives of many persons with disabilities.
Moreover, even if the helper correctly judges that the person needs
help, he may lack the necessary experience as to just what to do to be
most helpful. For instance, how could a sighted person realize without
being told that it is better for the blind person to touch him lightly than
to be held closely while crossing the street? Add to this the consideration
that all too often the helper's own needs for a pat on the back or for
reassurance that he is better off get in the way, and the advice offer but
don't persist becomes obligatory.
Since the person with a disability may be too proud or otherwise
restrained to ask for needed help, there is justification for sometimes
offering help rather than waiting to be asked. However, only under special
circumstances should continued efforts to help be made in the face of
resistance by the recipient and generally in these instances the help should
be offered again rather than administered without his consent. (See the
case of Mary, p. 175.)
The second principle refers to the manner in which help is executed.
The subjects strongly opposed all fuss and emotional display in helping.
Ostentatious help conveys a feeling that the helper is enhancing his own
self-satisfaction at the cost of one less fortunate. Rather, help should be
offered matter-of-factly, in a way that is pointed to the demands of the
situation rather than to the help relationship itself.
These precautions will minimize the danger that such experiences as
the following will occur:
I went out with a teacher to a concert; we travelled by bus. I have enough
vision to get on and off a bus without being told when to step and being clung
to as if I would run away. Every time there was a step she would say "Step" in
no quiet voice and I know everyone was looking me up and down. It made me
feel like crying [Sommers, 1944:32],
232 Physical Disability — A Psychological Approach
Help offered matter-of-factly diminishes the possibility that help will
be useless or hindering. It gives the person with a disability a chance to
reject the help or to explain how it can best be performed. And most
important of all, negative implications of subservience and inferior status
will be minimized.
The authors of the help study also advance several penetrating recom-
mendations to the person with a disability. They point out that the re-
cipient could well take cognizance of the fact that the act of help in itself
cannot be taken as a measure of how he is regarded, for refraining from
helping may place more emphasis on the disability than casually offering
assistance. They also point out that restricting help to situations of abso-
lute necessity may foolishly eliminate much useful assistance. What is
most important is a reinterpretation of the meaning of help — that is, of
the reasons for which it is offered by the helper and accepted by the
recipient. Just as help is offered to "normal" persons not because of their
general state of helplessness but merely because a situation seems to call
for help, so may a person with a disability realize that it can be offered
to him not as to a disabled person but as to someone who is having dif-
ficulties in particular situations. This involves a reorganization of the
self-image, for as we have seen (Chap. 7) the self-concept is central to
the interpretation of social relationships.
Perhaps these points sound obvious if not platitudinous. If so, the
obvious needs to be extricated from the dull and uninteresting. Considera-
tion of help can no longer be neglected, for help is a problem. All too
often the helper barges in and is so intent on letting the recipient or the
wider group know of his solicitousness that what could have been
welcomed help is resented. Likewise, the recipient all too often sees in
the help relationship another indication of his inferiority whereas actually
it is an expression of good will toward a person having difficulties in the
particular situation.
Although the discussion of help referred explicitly to the narrower
sense of bodily assistance, the reasons for approving and rejecting help
as a social relationship or as an expediting act apply to nonphysical help
situations as well. Criddle, for example, with vision poor enough to be
classed as legally blind, could not accept the services of an agency for the
blind, even though he was desperately in need of employment during the
depression days. Sheltered employment meant to him dependency, help-
lessness, personal and social admission that he was inferior (Criddle,
1953: Chap. 21). Likewise, emotional help as expressed in sympathy can
be welcomed or distrusted, depending on the form it takes and the mean-
ings conveyed to the recipient. It is to the emotional relationship of
sympathy and pity that we shall now give our attention.
Grievances and Gratifications 233
THE PROBLEM OF SYMPATHY
Sympathy, that basically human expression of warm concern of one
person for another, does not always afford consolation. The same factors
that were significant in the evaluation of curiosity and help apply to the
evaluation of sympathy: self-regard, situational and personal context,
wish for adjustment and desire to be understood, the behavior of the
agent. Instead of detailing these factors again, we shall analyze the problem
of sympathy in a somewhat different way. Unwanted sympathy will be
examined first, followed by the kind of sympathy that is potentially
acceptable. The latter will be examined in terms of the fundamental
nature of the sympathy relationship. The discussion is based essentially on
the work of Dembo and her associates (1956, Chap. 6).
Unwanted Sympathy
Sympathy may be rejected because of the desire for privacy. This
occurs, most commonly, when the recipient wishes to hide his disability
or at least to act as if it did not make any difference to him. It also
occurs when the person wants to be left alone with his feelings because
he needs to mourn (see pp. 109-115), because he does not wish to
burden others with his troubles, or because he feels he must first get hold
of himself.
Sympathy may also be rejected when the recipient senses contaminating
attitudes in the other person, such as devaluation or insincerity. Pity as
we shall use it presumes a status relationship in which the agent looks
down upon the recipient; it involves devaluation even though the agent
may wish to help the sufferer. Sympathy contaminated with pity is
surprisingly easy to detect. The following examples show how difficult it
is to camouflage the feeling of devaluating pity. In both cases the agent
probably would have acknowledged only the most honorable motives, but
the undercurrent of pity makes a travesty out of the seeming benevolence:
John, a spastic boy, related, "I went to the theater with my mother. A
stranger walked up to her and said, 'I'm awfully sorry your son turned out this
way'" [Foster, 1948:9\.
Nancy, a young girl, said, "I was sitting in the waiting room at a depart-
ment store. A woman came up to me and offered me a quarter. She said it was
because of my 'little crippled legs' " [Foster, 1948:9].
Pity that produces the feeling of being devaluated and not worth much
tends to cause additional suffering. Of all the attitudes of another person
to the self, it is among the most hated.
234 Physical Disability — A Psychological Approach
Insincere sympathy may be expressed by the agent for the purpose of
adhering to the ethical ideal of being a good person. Sometimes this
implies self-aggrandizement, in which case it is resented. However, in-
sincere sympathy may be evaluated as proper when seen as a formal
expression of politeness. Here the agent conveys only a recognition of the
seriousness of the event and his intention not to intrude further into the
privacy of the recipient. Formal sympathy, therefore, bears no great
dangers, but the investigators of the sympathy study caution that it should
emphasize the event and not the man: To say, "I'm sorry it happened"
conveys what is needed. "I'm sorry for you" may connote devaluation.
Resentment may also be incurred when the recipient, mistaking the
sympathetic overtures for genuine feelings, assumes a concern that does
not exist. Should the recipient confide in the agent, he is left with a
feeling of having been used, cheated, or shorn of his protective defenses.
Even when the recipient may be ready to accept sympathy, he may
find the relationship a disturbing one because of certain ineptitudes in the
agent. What, then, does characterize acceptable sympathy? How should
sympathetic persons act? The specifications as to appropriate behavior can
be seen as fitting into a human relationship that has a coherent underlying
structure.
Nature of Potentially Acceptable Sympathy
The fundamental characteristics of sympathy, as delineated by the
investigators of the sympathy study, are congruence, understanding, and
readiness to help.
In a sympathy relationship, the feelings and perceptions of the agent
and the recipient are not and cannot be identical because the content of
their distress is different. The recipient is distressed over the loss itself,
the agent because the recipient suffers. Their moods need not be similar.
If someone is depressed, the sympathizer need not also become depressed.
Instead of identity, what is required is a congruence of feeling and under-
standing of the participants. Congruence rather than identity, moreover,
would seem to hold a better potential for diminishing the distress. Not
only do different points of view introduce new angles, but the sympathizer
can well remain free of the anxiety and fearfulness of the person in
distress since these emotions act as barriers to realistic evaluation of the
situation.
What makes for congruence in emotional relationships needs further
study. We do know that gay attempts to divert a person suffering a loss
will be felt as incongruous and "rub him the wrong way." The sympathy
study also points out that expressions of concern that are immoderate may
be very disturbing to the recipient. The reasons are several: The recipient
Grievances and Gratifications 235
may be emotionally so keyed up in regard to the whole disability situa-
tion that additional emotion is difficult to bear. Any strong emotional
expression may also make the person feel that his situation is even more
unfortunate than he thought it to be. It may arouse feelings of guilt in the
person at having caused so much distress in others. It may lead to embar-
rassment because the person does not know how to act in the face of
strong emotion. Furthermore, excessive emotionalism may lead the person
to doubt the sincerity of the feeling and to sense self-aggrandizing
motives. What is equally important, excessive emotion has the danger of
making the agent imperceptive to the shifts in feelings and needs of the
sufferer. Just as music may be cacophonic or harmonious, so may the
array of emotions between two persons clash or be in tune.
The second essential to sympathy, understanding, requires first and
foremost that the agent give sufficient weight to both sides of an under-
lying conflict in the sufferer, the conflict between wishing to remain pre-
occupied with the loss on the one hand and wishing to escape the negative
character of the situation on the other. Thus, the agent must have suf-
ficient respect for the distress itself (even if he is not aware of its cause
or ramifications) and not try immediately to dissipate it. The investigators
of the sympathy study provide the following example:
... a mother may be genuinely concerned over the unhappiness of her
adolescent daughter, but if she tries to soothe her by saying, "It's only puppy
love. You'll soon forget all about him," the daughter, even when recognizing
her mother's concern, will feel that she doesn't understand and thus that she is
not really sympathetic. Similarly, if someone tries to "cheer-up" an injured
friend by saying, "Oh, you'll soon get a new leg," he may be felt to take lightly
the feeling of loss which the injured man experiences. It is equivalent to saying
to someone bereaved, "You'll soon get a new wife!" [Dembo, Levi ton, Wright,
1956:2%l
At the same time, because the sympathizer wishes to help bring about
emotional relief, he may with impunity try to emphasize certain positive
aspects of the situation as long as his efforts are not taken as a defection
from matters of great moment to the sufferer. In this way both sides of
the conflict are respected.
The investigators point out that the word "understanding" does not
imply only a conscious intellectual appreciation of the diverse meanings
of the loss for the recipient. "It seems as though there is such a thing as
emotional understanding — that is, grasping the emotions of the other
person directly on the emotional level without the intermediate step of
intellectual realization of these emotions" just as one may spontaneously
catch a ball suddenly thrown to him without intellectually deciding on a
236 Physical Disability — A Psychological Approach
course of action (p. 29). An excellent example of such emotional sensi-
tivity is seen in the following example of a mother comforting her son.
Ohnstad, when a young high school boy, knew he was going blind. He had
not been able to go to school during the past year, and the fear of blind-
ness was overwhelming. His mother emotionally understood. Ohnstad
recalls:
I looked in the mirror many times daily to see if the redness in my eyes was
going away. Sometimes they seemed clearer, and hope returned. When they
looked redder than before, my heart sank. There was a strange tightness in my
throat, a vague feeling of dread within me. The lids felt hot. When I awoke in
the morning, matter had dried upon my lashes and sealed them together. I
brooded over the fact that my classmates were going ahead in school while I
sat at home doing nothing. I was being left behind.
Mother called me into her room one night.
"I thought you might like to have me read a little from the paper," she said
as I stood in the doorway, blinking at the light. Her intention was, I knew, to
try and cheer me up.
"There's a story here," she said. "I thought you might like to hear it." She
read a few lines in her laborious broken English, then she stopped. "I wouldn't
feel so badly about it if I were you," she said, apparently divining my thoughts.
"Even if you have to stay out of school one year, that's nothing. You can catch
up again easily."
I said nothing, but the tears welled into my eyes and trickled down my
cheeks. Mother's voice faltered. She dabbed her eyes with her handkerchief. "I
know it's hard," she said brokenly, "It's hard now, but some day — some day
things will be better" [Ohnstad, 1942:2l-22]^o
"I know it's hard, but some day things will be better" is the core of
emotional imderstanding; it recognizes both the absorption with the
difficulties and the need for eventual overcoming of the distress. Such
emotional understanding can take place in young children. A child,
without knowing the facts or understanding the implications, can sense
distress in another and convey real sympathy.
The importance of emotional understanding by no means relegates
intellectual understanding to second position. Intellectual understanding,
by giving rise to useful suggestions that the recipient may be ready to
accept, may increase the effectiveness of the help offered.
The third essential of sympathy is a readiness to help the recipient over-
come his distress. Concern that does not carry with it a willingness to put
oneself out for another is felt to be insincere or at best a formal expres-
sion of sympathy, otherwise empty.
10 Karsten Ohnstad, The World at My Fingertips, Indianapolis, The Bobbs-
Merrill Company, 1942. By permission.
Grievances and Gratifications 237
But what can the sympathizer do to help? In a particular situation,
concrete suggestions may be appropriate, as when the agent informs the
person of rehabilitation facilities. What we are after, however, is not a
listing of the concrete ways of sympathetically "saying and doing," for
this is limitless, but rather some guides that can apply to the sympathetic
relationship in general. Dembo and her associates (1956) propose one
important guide — namely, that the agent should be passive or active,
depending upon the recipient's wishes and upon the recipient's momentary
tendency to remain absorbed with his suffering or to escape from it. They
point out that a deep positive feeling on the part of the sympathizer can
be conveyed without demonstrative manifestations. There are times^
probably not infrequent, when the sympathizer can help best by just
"standing by"; there is a mutual understanding that, as the situation
warrants it, the agent is ready to participate more actively. This requires,
that the agent be sensitive to the occasions when he can strengthen the
forces in the recipient to meet and overcome his suffering without provok-
ing resistance from him. The authors of the sympathy study point out that
the sympathizer must be ready to abandon any benevolent attempts at
the first sign that he has proceeded beyond the ability of the recipient to
follow him. Because the sympathizer wishes to help, he may proceed too
quickly in his efforts to cheer the sufferer and even become impatient with
the recipient's slow pace at overcoming his sorrow. The sympathetic
person emotionally understands that "haste is made slowly" and thus his
help is a readiness that ideally is transformed into more active participa-
tion as he receives cues from the recipient concerning the kind of help
that will be most constructive. The actual adjustive value of the help will
depend on the wisdom of both agent and recipient, though it is altogether
likely that sympathy as an expression of we-group feelings, giving assur-
ance that one is of worth to another person, always has some adjustive
value.
Recommendations to the sympathizer as to how he may best serve the
recipient have necessarily been woven into the discussion of the nature
of acceptable sympathy. Management by the recipient of unwanted
sympathy will not be described here, for sufficient material to understand
the nature of such attempts has already been given in regard to the
situations of curiosity and of help.
THE PROBLEM OF SOCIAL PARTICIPATION
"How can a blind guy be a member of the gang?" (Griddle, 1953:20).
Tn this way young Criddle was challenged when he returned to the club
of which he had been a member until his accident had destroyed almost
238 Physical Disability — A Psychological Approach
all his vision. And for the first time he feared blindness with a terror more
blinding than his sightless eyes, for the consequences of blindness seemed
irrevocably to include social ostracism. When a person with a disability
fears his disability, he may above all fear that he will be left behind, that
he will be out of the running, that he will stand alone, excluded from
normal group activities.
"Treat Me Like Anyone Else"
In a desperate defense against threat to social acceptance and participa-
tion the person not uncommonly appeals to the world with the exhorta-
tion "Treat me like anyone else!" Underlying this may be the fervent wish
to hide the disability, to act like a nondisabled person, and to be treated
like a nondisabled person. This was true in young Ohnstad's case during
his early adjustment to his blindness. At that time he needed the convic-
tion that he was just as he was before, that blindness in fact made no real
difference. To prove this illusion he had to maintain the standards of
sighted behavior as his own:
I preferred the bruises, however, to walking around with my hands stretched
out before me. It was too conspicuous. 1 did not want to be stared at and
looked upon as helpless and different from others. And so I continued to bang
into doors; and chairs out of their accustomed places continued to bruise and
cut the flesh on the front of my legs with their sharp edges. At night my socks
had grown fast to my skin, and I had to pull the scabs off with them [Ohnstad,
1942:45, italics ours].
To maintain this illusion, Karsten Ohnstad had to insist on being treated
like anyone else. He even wanted people to laugh at him when he fumbled
and stumbled just because this reaction would have been eHcited in the
case of a nondisabled person (p. 45).
But had they indeed laughed, Ohnstad would have felt just as hurt; in
either case, the silence or the laughter would have been seen as stimulated
by the fact of his blindness. As long as he regarded this fact as a devaluat-
ing one, identity of treatment would remain impotent to effect a com-
fortable acceptance in social participation. Actually, identity of treatment
in many instances may point up a difference that could remain quite
unobtrusive with special treatment. Serving steak to an arm amputee
because he should be treated like anyone else would more certainly call
attention to his disability than had a more manageable main dish been
planned. Identity of treatment may boomerang in yet another way, for
unless one allows for modifications in the situation, the injunction resolves
itself into an all-or-none rule: either one treats identically or one does not
treat at all; that is, the person becomes excluded from the situation.
Grievances and Gratifications 239
It is necessary to realize that special treatment in itself does not mean
stigmatizing treatment. One does not debase a deaf person because one is
careful to provide adequate light for lip reading. One does not debase an
amputee because one gears the step to a more leisurely pace. Debasement
does not depend upon how similar the treatment is to the usual pattern,
but rather upon underlying attitudes.
Inclusion Through Accommodation
Instead of identity of treatment serving as the guide to social behavior,
the person with a disability and those around him should think rather in
terms of how the person can best participate. And with this thinking new
and varied possibilities emerge. A lame boy plays baseball :
I played with the boys of the neighborhood, sharing in all their games and
sports, even baseball. I was catcher, since that position required less getting
around, and when it came my turn to bat, another boy ran the bases for me
when I hit the ball [Goldman, 1947:53-54].
The following account of a party that Ohnstad as a blind college
student attended is reported at some length because it demonstrates how
a series of accommodating modifications evolved as a natural process:
At first those who invited me — and I myself — took it for granted that I could
take no part in the fun-making. Parlor games were made for sighted persons,
not for blind men. It was better for me to remain safely in one spot than to go
galloping about the room crashing into furniture and knocking over the
statuary. And so, while the others played games and had a good time, I sat in
an easy chair Uke an old grandfather, smiling at the shouts and laughter of the
youngsters and wistfully recalling the lost days of my youth. . . .
The girls who selected the games, however, were on the alert.
"You can play this one as well as the rest of us," Nan said. "All you've got
to do is think about what the one who is thinking is supposed to be thinking,
and — "
To everyone's surprise, there were more games that I could take part in than
we had imagined.
"Bring your marked cards along," Chet reminded. "We're going to play five
hundred or bridge or something."
Braille cards were a novelty to the others at the party.
"What are all these dots on here — flyspecks?" Joe asked, staring at the cards
as I dealt them around.
Patty held a card out before me. "But how can you tell which is which?"
I explained the system of initials and numbers. "See these three dots? That's
the letter J. And these two dots next to it? That's the letter C — the jack of
clubs." . . .
240 Physical Disability — A Psychological Approach
Very soon I was taking almost as active a part in the fun-making as anyone
else. ... A delegation of four marched into the room.
"We are supposed to guess by their actions what book they are trying to
represent," Clara said. "Two of them are sitting on the floor and another is —
well, looks as if she's got a long stick and is trying to jab holes in the floor.
Bob is waving his arms in a big circle as if he were turning wheels."
Bob moved slowly from one end of the room to the other uttering a dull,
monotonous "hooo! hooo!" That was easy. He was a boat of some kind. Maybe
a freighter. There was no book represented in all these indications of adoles-
cence that I could make out, unless it could have been "Wynken, Blynken and
Nod."
The two sailors on the floor began talking.
"Keep your head down until we get past!" The voice was piping and as
boyish as a girl could make it.
"Yas sah! Dey nebbah see me whuh ah is!"
This was confusing. It might have been Robinson Crusoe and his man
Friday, but where did the steamboat and the boy with the fishing pole come
from!
"Ships in the Sky!" The audience was off to a catalogful of titles: "Show-
boat!" "Nigger of the Narcissus!" . . .
"Three Men in a Tub," I shouted. "Twenty Thousand Leagues Under the
Sea."
Jack leaned toward me from the other end of the davenport.
"What would a steamboat be doing twenty thousand leagues under the sea?"
"That's right," I said, turning to my informant and back to the actors again.
"The Wreck of the Hesperus!"
"I don't know what they'd be doing with that pole unless they were on a —
I've got it!" Clara jumped up excitedly. "Huckleberry Finn!"
"Right!" . . . [Ohnstad, 1942:208-211].
Participation was made possible at this party because Ohnstad was not
treated like anybody else. Games were selected in which he could get
along with little or no help; Clara described a little bit of the charades to
him as they were being enacted; Alice helped him write down the
geographic names; Ohnstad himself felt free to ask for some readily
available equipment so that he could write on his own.
All this is special treatment, but when it is inaugurated and executed
matter-of-factly according to the requirements of the situation as they
arise and change, special treatment can have the psychological feel of
being treated like anyone else, for it is then that the person is not set
apart from but is made a part of the social group. The lame boy who
played baseball by having someone else run the bases for him felt, "I won
my battle for equality among my fellows. They perceived that I wanted
no special consideration and they gave me none" (Goldman, 1947:54).
The special treatment was not felt to be special at all. It was so natural a
Grievances and Gratifications 241
requirement of the situation that it led to a feeUng of equality; in order
to treat him as a person like anyone else, one had to allow special treat-
ment for that part of his tool equipment which was inadequate to the
situation.
The point is an important one and should not be glossed over with a
glib acquiescence that merely pays token agreement to its substance.
Participation is a preeminent requirement of group belongingness and
acceptance. Without it the person all too often feels truly "different,"
abnormal, and not wanted. This is brought out by a young man both of
whose legs were paralyzed when he was three years old; after learning to
swim, he asked these questions:
Why did I have to wait until I was 21 to learn I could be like others? Why
did I always have to go to study hall when the others went out to play?
[Daniels, 1948:20].
What this man is decrying is his exclusion from activities which he
could have entered. When he learned to swim, he was struck by the
remarkable thought that he could do things that others did even though
the performance was styled to fit his own idiosyncrasies. It was then that
he began to feel like others, in spite of the fact that the details of his
performance were different. New Fountains, a provocative play about a
16-year-old girl who recently had polio, presents a clear demonstra-
tion of how participation in the social life of her high school helped her
feel a part of the community of other young people (Gilmore, 1953).
This is not to say that situations should always be accommodated to
the needs and wishes of a person with a disability. There are occasions
when the necessary modifications might place an undue strain on the
group. For example, a deaf person, even though a proficient lip reader,
has difficulty functioning in a large group discussion, and to require the
other members always to face him and to watch for signs that he has lost
the trend of the conversation would interfere not only with the free flow
of discussion but also with the level of intensive thinking. In these
circumstances, however, it should be left up to the person with the dis-
ability as to whether or not he wishes to join the group even though little
special attention can be given to his individual needs. He may wish simply
to get as much as he can from the occasion, or perhaps even to enjoy
the presence of others. At the same time he may decline the invitation,
and the danger that his absence will be ascribed to social rejection is less
likely to occur.
As part of the Dembo study, serious thought was given to the problem
of participation and social acceptance (Ladieu, Adler, Dembo, 1948).
The investigators point out that exclusion from certain activities because
242 Physical Disability — A Psychological Approach
of the realities of a handicap is totally different from the exclusion that
stems from social rejection. In the former case the person may miss the
activity, but in the latter case he is also hurt by the affront, which says in
effect, "You are not good enough to associate with us. Keep your dis-
tance." The person with a disability may feel socially rejected (even
though objectively this may not be the case) when he is kept from par-
ticipating in activities that he believes he could manage.
The Dembo study also points out that the problem of social participa-
tion is complicated by the discrepancy between what the person with a
disability sees as his limitations and what others see (Ladieu, Adler,
Dembo, 1948). Frequently, when others judge that certain physical
characteristics preclude an activity, the person himself knows that he can
manage. The phenomenon of spread (see pp. 118-119) is one important
factor responsible for this discrepancy. The recommendation is made that
since the nondisabled person in most situations involving social participa-
tion cannot readily acquire information as to the variable capacities of the
person with the disability, a willingness to have him participate should
be indicated, the judgment as to whether or not he will be able to do so
being left up to the person himself.
THE PROBLEM OF RIDICULE AND TAUNTING
With civilized acceptance of the "Golden Rule" and the proprieties of
good social form, outright ridicule and taunting of a person's physical
imperfections are permitted only under special circumstances. Social sanc-
tion is given to ridiculing one's enemies; during wartime, cartoons fairly
revel in caricaturing the physique of the opposing forces. In political
campaigns remarks about vulnerable physical attributes of an opponent
may be made. Where there is no evident reason for vindictiveness, how-
ever, ridicule may be permitted if the intention is to evoke some positive
effect in the recipient. For example, an adult may belittle a child for
spilling food over himself in order, presumably, to encourage more mature
eating habits.
Requirement of MournI;?fr
The requirement of mournmg makes possible a deeper understanding of
the motivations behind devaluating pity, ndicule, and taunting (Dembo,
Leviton, Wright, 1956:21). This hypothesis states: When a person has a
need to safeguard his values, he will either ( 1 ) insist that the person he
considers unfortunate is suffering (even when he seems not to be suffer-
Grievances and Gratifications 243
ing) or (2) devaluate the unfortunate person because he ought to suffer
and does not. This implies that the devaluer wants the unfortunate person
to suffer. He wants him to suffer as a sign that the values denied the un-
fortunate person are still worthy and important and good. Especially if
his security depends upon maintaining these values will he insist that the
unfortunate person admit his suffering. "Consider a woman to whom
'position is everything in life.' She must consider as unfortunate those
who are omitted from the social register. If she does not it would mean
that her position is not so valuable after all. If they do not accept the fact
that they are unfortunate, she must consider them either too stupid to
know better, or insensitive, or shamming; otherwise her own position is
threatened" (Dembo, Leviton, Wright, 1956:21).
This is why the bully is typically a person beset with inferiority feelings.
By deriding another he gives himself a pat on his unsupporting back.
This is also why some members of minority groups disdain other minority
groups that they consider lower on the social scale.
In ridicule and taunting are found the most blatant expression of the
requirement of mourning. The kind of ridicule undertaken solely for the
purpose of seeking personal advantage in the suffering of another is
ethically taboo. Because it is so untutored and open, it is more frequently
the instrument of children, who have not learned the more sophisticated
ways to express their needs. Unfortunately, it is also children who bear
the brunt of ridicule, children who may be quite defenseless to cope with
the unrelenting jeers. An indication of how common this form of self-
aggrandizement is in children is given in a study of the nicknames of
children living in an orphanage (Orgel and Tuckman, 1935). Nicknames
of both boys and of girls referred to physical defects in about one third
of the cases. Virtually all such nicknames were derogatory and produced
resentment and ill feeling.
Among adults ridicule generally occurs more covertly, though open
ridicule is by no means nonexistent. A man whose face is paralyzed on
the right side reports that on the job ". . . the fellows made my life
miserable. They would tell jokes and make faces the way I do when I
talk. Or they would say 'are you trying to be tough, talking out of the
side of your face?'" (Macgregor, i95/.-634). Usually, however, the ex-
pression of ridicule by adults seems to be more subtle; it may assume the
character of devaluating pity cloaked with sympathetic overtones. So-
called playful teasing in some instances may be a more artful expression
of underlying ridicule. On the basis of interviews with 200 male college
students taking corrective physical education, it was concluded that
experiences with adults were far more pleasant than experiences with
children of the atypical child's own age or younger (Stafford, 1947:S0).
244 Physical Disability — A Psychological Approach
Management by the Recipient
What does a young child do who is the object of taunts and jeers? He
may try to strike back, but when his uncertain attempts are of no avail,
his desperation is given vent in crying that is full of anger and hurt.
Henry Viscardi, markedly dwarfed as a result of congenitally deformed
legs, presents a heart-breaking account of just such an experience. The
scene is his first day at grade school:
Mamma and Papa had wisely chosen a flat in the same block as the school.
It was on 101st street near Amsterdam Avenue. My sister Terry took roe to
school the first day. Clutching her hand I hoisted myself up the steps to the
schoolyard. It was crowded with children, bouncing balls, playing hopscotch,
and running up and down the steps. I had never seen so many children, not
even at the hospital. And these were all so big. I tried to back away.
"What's the matter, Henry?" Terry patted my shoulder. "You'll be all right —
soon as you get used to it."
Then I heard loud laughter. "Hey, Louie, looka the ape man."
Three big boys came toward me.
"I'll show you where your room is." Terry jerked my hand.
The laughs grew louder. "Come on, Henry," Terry urged. Her cheeks were
red.
The crowd of jeering boys had grown. One of them, who had a thin face
and dirty, light-colored hair, came over and shoved me. I shoved back, against
his knee.
"Oh, you wanta fight, kid?"
"Cut it out, Mike," somebody yelled.
"You — you — leave my brother alone." Terry almost cried. But the circle of
boys held us in.
"Hey, ape man, what you got tied to your feet, boxing gloves?"
I looked down at my mismatching boots. They weren't a bit hke the shoes
the other boys wore.
"I want to go home." I hung on Terry's arm, tears rolling down my cheeks.
"Sissy, sissy. . . ."
Another big boy shoved me. I lost my balance and sprawled on the cement.
Terry helped me up and brushed the dirt off my clothes. I started swinging my
arms. The crowd pressed in and I couldn't see my sister anywhere.
Then the bell rang, and the boys ran into the building. Terry came back.
"Here," she said, "blow your nose." She gave me her handkerchief. "Your
hand's bleeding." I thought I saw tears in her eyes.
"Come on," she said. "I'll take you to your teacher" [Viscardi, 7952.13-14].
Henry Viscardi's first day at school — Raymond Goldman's first day at
school (see pp. 145-146). How alike they were!
As such incidents recur, the recipient tries one way of reacting and
Grievances and Gratifications 245
then another, hoping to find some way which will be effective. Russell
Criddle reviews his attempts to cope with ridicule as a young teen-ager
with extremely poor vision.
There had been some teasing, some mimicry which I had already learned to
tolerate during my first few years as a handicapped person. I knew that I must
never retaliate to the various negative reactions which children usually had
toward me. The best way, I had learned, was to pretend not to be hurt, and I
sensed that in this way I eliminated the feeling of remorse that both I and
others would suffer if I showed resistance, or retaliated. This submission, I
think, balanced the distress caused others by my handicap.
There were a few boys of the little-bully type who wouldn't let me disregard
their reactions. I tried a benevolent, understanding attitude toward them, an
attitude which said to the rest of the class, "They don't hurt me. I know my
eyes are funny, and it doesn't bother me if they laugh."
But what was, in truth, humility struck them as aloofness, and they were
further irritated. In pretending not to be hurt or not to notice them I supplied
sustenance for their stupidity and their insensible concepts of blindness.
I tried to make friends with the boys, to be one of them, entering into what
they wanted to consider a game of wits — laughing with them when they
"pulled a good one," covering up for them if they were caught by the teacher.
Once one of the boys, pretending to be engrossed in study, let his foot stick
out into the aisle so that I would trip over it. The teacher hadn't seen his foot,
but I know she suspected when she asked, "What happened, Russell?"
"I shpped," I said with a laugh. The teacher understood, as did the rest of
the class, and I can understand how this added to the irritation of the boy who
had tripped me. He was winning the scorn of everyone. Matters soon reached
the stage of a running conflict. . . .
... It was in study hall. The teacher was out of the room, and I was reading
a history book. I had not noticed Mike [a schoolmate] as he walked down the
aisle toward my desk and was not aware of him until I felt the pain of a blow
against my knuckles. He had struck them with the sharp edge of a foot rule,
the kind which had a thick piece of metal imbedded along one edge.
I didn't flinch, I didn't move.
He hunched his buttocks upon the top of my desk so that he was half sitting
there. I raised my head until I was looking into his face. I could see that he
was smihng.
"Don't you have any feeling, Criddle?" he asked in a matter-of-fact tone. I
stared at him, and he struck my knuckles again.
Someone said, "Aw, Mike, cut it out!"
"I'll stop when he asks me to," Mike said. He struck again. . . .
He was saying, in effect. Look, he isn't like us. He doesn't feel pain, and
loneliness, and hunger. Blindness makes him different. It makes him defense-
less. There is nothing he can do but let me hurt him until I get tired of the
sport. This is fun, look at me smile.
I let my eyes fall to my knuckles. They were bloody.
246 Physical Disability — A Psychological Approach
Afterwards I was told that I just stared at my knuckles for a moment and
then screamed and lunged at Mike with a force that knocked him across one
row of desks into another aisle. I sprang after him, pounding his face with my
bloody knuckles until he called for help. Then I started choking him. I
remember Mr. Singleton pulling me away and leading me, hysterical, to the
boys' washroom [Criddle, 7955:98-99, 101-102].
The strategies attempted by Criddle over the years were:
Not to retaliate. To pretend not to be hurt.
To be benevolent and understanding, an attitude that says, "I know my
eyes are funny, and it doesn't bother me if they laugh."
Not to notice the jeerers; to ignore them.
To join the jeerers by ridiculing himself and covering up for them.
To return the attack; to retaliate with physical force.
Actually, none of these tactics could be effective in all or even most
situations, for as long as the attacker needs an inferior to sustain his own
uncertain status, he will keep probing until the desired response of suf-
fering is elicited. That is why ignoring the jeers, or showing understanding
of them, or submitting to them only provokes more vigorous attacks. The
bully must get the unfortunate person to agree that he is a lowly creature
and to suffer.
The method of active retaliation is effective only when the person is
fortunate enough to be stronger than the attacker. Then the bully does
not dare provoke that person again, but will instead turn to an easier
scapegoat. The bully seeks another scapegoat, because the defeat at the
hands of the first has injured his vulnerable self-esteem still further, an
insult he hopes to avenge by forcing inferiority on someone else through
the requirement of mourning.
In the discussion of curiosity, it was seen how the recipient may
actively retaliate in nonphysical ways; reciprocal jeering is parallel to
biting sarcasm (see pp. 212-213). This again is effective only when the
recipient is more masterful at this game than is the bully. Too often a
child who is physically handicapped is so humiliated that the control re-
quired for effective sarcastic retort is denied him. Weak submission, pre-
tense, and angry attack seem to be easier defense mechanisms.
Recommendations
What, then, is the answer, if there is no fully adequate way for chil-
dren to cope with ridicule? It is our opinion that extraordinary care should
be taken to cut down as far as possible exposure to ridicule. All too often
the child "learns" to agree with the bully that he is indeed a pitiful object
that ought to be scorned. Moreover, the power of ridicule to defeat the
Grievances and Gratifications 247
recipient is so great ttiat even a single such attack in childhood can leave
emotional scars.
The most general need is for the development of wholesome attitudes
toward disability through education at all levels of community life. In
accord with democratic principles, education against religious and racial
discrimination has been encouraged, and only recently has serious atten-
tion been given in the schools to the necessity for education in the over-
coming of prejudice toward persons with disabilities. We need good
visual aids and other methods in the elementary and high schools to
inform children that physical attributes and styles of life differ widely
among individuals, that within this assortment of differences lies the
common core of the human being, that differences per se need not make a
difference in many important areas of living together. If these views were
part of the broad teaching of community and school, the problem in the
case of a single child would be vastly simpler.^^
One of the most important arguments in support of integrating children
with disabilities in the regular public schools is that it provides the
opportunity for all children to become familiar with and accustomed to
differences. However, just grouping children together does not necessarily
provide good group experiences, either for the children with disabilities
or for those without. This is an area that begs for serious investigation.
Below is a demonstration of how role playing can enlighten the able-
bodied child toward more mature acceptance of physical deviation. In
role playing, persons are assigned to various roles and act them out. The
psychodramatic episode took place in a home, but its application to set-
tings of groups of children is apparent:
Larry, a 5-year-old, talked about Kate, a child in his class who had
some diJEculty in walking owing to a birth injury. He remarked, "Guess
I'm lucky to be all right and not be stiff in the legs like Kate." A
few days later he made some remark to the effect that he and the other
children thought Kate was a dope. She could not do the things they could
do. Soon after his mother suggested "that they play a game and that he
should get hurt by a car and that he would go to the hospital and then
get better."
Larry. "Here I am in the street, and a car comes whizzing along and clips
the tail of my bicycle so that I am thrown off on the street. Then my friend
^1 There is available an excellent instruction booklet for elementary school
teachers on how to introduce and discuss in the classroom the matter of Uving
with a physical disabiHty {Understanding the Disabled, 1956). The activities
and techniques suggested are designed to stimulate reevaluation on the part of
the children, leading to the development of adjustive attitudes toward disabiUty.
The procedures outlined include role playing and the discussion of stories and
incidents. For a brief description of these see pp. 268-269.
248 Physical Disability — A Psychological Approach
Jim (a much older and admired boy) comes along and trips over me so that
I get hurt."
Mother. "Yes, he accidentally runs over your leg, perhaps."
Larry is delighted and lies kicking on the ground in supposed pain. Mother and
nurse-sister come rushing along and put him in an ambulance and take him to
the hospital.
Mother. "Now I am the doctor. Hello, little fellow. What happened to you7
Oh, it is your leg. Say, it is pretty bad, and it will take a while to get well.
You will have to walk stiff-legged for a few weeks."
Larry. "You mean I can't run and jump any more?"
Doctor. "No, you must take care of it for a long while. I guess you can get
up now and try to walk." He lifts Larry onto his feet. "Oh no, you cannot
move like that. You must not bend your knee except by lifting it up by your
hand. See, when you want to go upstairs, you must raise the leg with the
hand like this."
Larry. "Oh, that is difficult. It makes my back tired before I get up the first
flight of stairs." He puts forth much effort and pulls each leg onto the next
step. He gets to the landing and sits down. "Say, this is not fun. Why are
we playing this? I want to get well soon."
The mother sits down a moment on the step too. "Well, Larry, did you
ever think of what Kate has to do when she walks upstairs? She never
complains but keeps right on trying. Don't you think she is brave and
courageous hke the soldiers were in the war?"
Larry. "Say, she is. I never thought of that before."
Mother. "Do you know how you can make it easier for Kate and have more
fun yourself?"
Larry. "No. How?"
Mother. "It makes Kate happy to have the boys and girls nice to her and not
impatient with her when she is slow about getting places. Perhaps you can
help the other children to be nice to her too. You know they think a lot of
you, and if you showed them that you like Kate and think she is brave, they
will not talk about her being a dope. That must make her feel pretty bad
like it would make a soldier feel bad if you said he was a dope because he
lost a leg fighting in the war" [Lippitt, Rosemary, 7947.157].
For the first time Larry assumed the "inside position" with respect to
disability problems (see pp. 63-64). This sensitized him to such values
as effort rather than achievement (see pp. 116-117) and to the aspect of
coping with the disability situation (see pp. 59-61). He was then able
to accept the evaluation that Kate's behavior was courageous and not
stupid.
To set up and direct a good role-playing episode takes more skill than
one might imagine. Wisdom and skill are also required to lead a well-
directed discussion or to organize a meaningful lecture. The leader utiliz-
ing any of the procedures above is on safe ground if the message is geared
Grievances and Gratifications 249
to the person with a disability rather than to the disabled person, to the
coping aspects in the situation rather than to the succumbing aspects.
Thinking along these Hnes can go far in developing adjustive attitudes,
not only for the benefit of someone else who is different but also for the
person himself, since he cannot excel in everything.
In addition to general preparation in the schools on the matter of dis-
ability, it is sometimes helpful to pave the way specifically for a child
markedly different who is about to enter school or any other group. This
has the possibility, at least, of abating inordinate curiosity and of leading
to some sympathetic understanding that this child who is different is for
all that a child who is the same. Sometimes the principal may be the best
person to lead the discussion, sometimes the individual teacher, sometimes
an invited speaker, and sometimes the parent. Karen's mother relates how
she went to speak to the kindergarten class the day before Karen was to
start school:
"I have a little girl, just your size, named Karen," I began in a conversational
tone. "She's nice and laughs a lot and has freckles and pigtails." I turned to a
tot at the nearest table. "But her pigtails are not as long as yours." I had done
enough public speaking to know when I had established "contact."
"Now God didn't make Karen's legs as strong as yours," I went on, "so we
have to help them get strong, so she can walk. Some children wear braces to
help their teeth and Karen wears braces to help her legs. There are some things
she can't do and some games she can't play. Sister will let some of you help
her once in a while. But don't spoil her!" I laughed as I stood up. I went over
to the doll house, admired it properly and asked the little lass in blue to show
me some of the furnishings. "We have a real bureau with drawers that go in
and out that will just fit in the bedroom. Karen will bring it tomorrow.
Good-by, Sister, good-by, kids," I waved [Killilea, i952.-lll].
The words were few and simple, but they struck just the right chord.
They prepared the children to see a child who is really a child, so much
like them, yet different in particular ways; a child who needs help, but
only some of the time; a child who is managing her difficulties and can
be part of the group.
Parents of children with disabilities may perhaps be heartened by the
realization that with maturity their children will be better able to cope
with ridicule and other difficult social situations and that among the adult
population the rules have changed. Although pity is common, the public
expression of ridicule tends to be more controlled. Viscardi was not
taunted during his first day at college as he was upon entering first grade.
In the last analysis we need to develop emotional security so that the
need to tear another person down in order to build oneself up will become
an insignificant factor in the social relations among men. The bully, too,
250 Physical Disability — A Psychological Approach
is a person with a handicap, and he too requires help and understanding in
the effort toward better adjustment.
Curiosity, discussion of the disability, help, sympathy, devaluating pity,
social participation, taunting and ridicule — these interpersonal relations
are especially potent in the lives of persons with disabilities. Study of them
not only shows that their significance is part of the broader problem of the
meaning of disability to the agent and to the person himself but points
the way toward more satisfying relationships. Such concepts as status
value, coping, succumbing, and spread appear again and again in the
analysis of everyday relationships and in the recommendations for improv-
ing them.
Yet a good deal of the burden in interpersonal relations will be borne
by the person with the disability himself. Although the pathology may
lie with the group, the person himself is the one who is annoyed or hurt
most directly. It is he who has to "take it," who has to handle the in-
eptitudes of his associates in the ordinary affairs of getting along. Because
so often his own management ameliorates or augments the difficulties,
training in social skills on the part of the person with the disability is very
much indicated. This topic is treated in Chapter 11.
10
Chapter
Sources of Attitudes Toward Persons
with Atypical Physique
The many aspects of the social psychology of disability already
explored in the preceding chapters have necessarily included discussion
of factors contributing to negative and positive attitudes toward persons
with unusual physiques. Among these may be mentioned the requirement
of mourning, physique as a value loss, the coping-succumbing dimension,
expectation discrepancy, and spread. These factors were selected as being
particularly relevant to the problem under discussion, but they hardly
cover the multifarious conditions that contribute to the development of
attitudes.
Because attitudes and their sources are crucial to the understanding of
man's reaction to disability, on both the behavioral and emotional levels,
the present chapter is devoted to a review of several additional and widely
diverse factors that could not readily be treated in other connections. They
concern primeval predispositions as examined in terms of reactions to
physical deviancy on the part of animals and in primitive societies. They
deal with perceptual and cognitive aspects that influence the apprehension
of cause-effect relations and the reaction to the different and strange.
They bear upon environmental influences as revealed in childhood ex-
periences and socioeconomic conditions. These topics were selected
because of the availability of highly interesting research and observational
material, because they indicate the range of considerations that enter the
problem of reaction to physical disability, and because in some instances
they challenge common preconceived notions.
REACTION TO PHYSICAL DEVIANCY AMONG LOWER ANIMALS
It is interesting that man sometimes explains his antipathy toward
persons with unusual physiques by pointing to comparable instances in the
animal world. Such similarity presumably implies that man's negative
reaction is fundamental or even instinctual. The attempt to understand
251
252 Physical Disability — A Psychological Approach
human behavior in terms of animal behavior has been referred to as the
"principle of genetic reductionism," and questioned in some scientific
circles (Scheerer, 1954:124 S.).
In any case, the facts of animal psychology clearly debunk the myth
that animals in general ostracize the physically deviate of their kind.
Maisel (1953, Chaps. 4-6) has collated many anecdotes and objective
observations of research workers concerning the reaction of fish, birds,
and mammals to physically exceptional members of their species. A
sample will show the heterogeneity of reaction among various species:
Goldfish with amputated fins live "happily" among their fellows.
Sharks will converge on a wounded shark and eat it.
Some ants do kill their old and enfeebled. Higher ant forms do not.
Termites eat their injured, but notably where there is a shortage of
nitrogenous food.
An albino penguin was observed to be loved by his family but received
with hostility by strangers.
Among fish, unusual coloring is of no importance.
Baboons are ruthless toward their physical inferiors.
The wolf does not attack or avoid physically atypical wolves.
Among chimpanzees, taking the part of the underdog is not un-
common.
In the light of such variability, Yerkes, the psychobiologist who has
worked for half a century in the field of animal psychology, has said, "I
am quite unable to make with confidence any general statements" in
regard to the reaction of animals to the disabled (Maisel, 1953:538).
Maisel, in his extensive review of this matter, has hazarded a bolder
statement about icthyological ways: "If there is, indeed, a law of the deep,
it might well be that anything goes, and all kinds of atypical bodies can
survive" (1953:419).^ Sometimes, of course, a weak member may not
survive because of competition for food and shelter, but this is quite dif-
ferent from ostracism and rejection.
The fact that the fable of the ugly duckling and the metaphor of the
black sheep live on as paradigms is again evidence of man's proclivity to
perceive the facts that fit and to fit the facts that do not. To make this
point more impressive, let us have a look at the ways of hens, the hen
being a domestic fowl under common observation. Everyone "knows"
that a hen is prone to peck, even unto death, another bird who has a raw
spot showing. This fact is retained and disseminated because it fits with
the preconceived notion — and, in some instances, the need — that physical
deviation and injury are anathema to mankind and life in general. The
^ Edward Maisel, Meet a Body, 1953, by permission of Institute for the
Crippled and Disabled.
Attitudes Toward Persons with Atypical Physique 253
fact that fowls do not react in this way to other kinds of physical irregu-
larities is not even noticed. A hen that is paralyzed, for example, will
maintain her pecking order and will not be relegated to the bottom of the
pile (Maisel, 7955.-516).
Another example that shows how "naturally" our preexisting ideas and
needs tend to perpetuate incorrect notions is provided by the legend of
the shark. Although it is an indisputable fact that sharks do destroy the
wounded members of their own species, the ready anthropomorphic
inference that this is motivated because of an aversion to deviation or of
fear of some kind is far from the truth. But typically one does not pursue
the why of the behavior, for when something is "all figured out," the
disturbance produced by new facts is not welcomed. It so happens, how-
ever, that sharks distinguish what is food and not food by olfactory cues;
the juices of an injured shark set up a chemical stimulus that brings on
feeding behavior in other sharks (Maisel, 1953:470). If the dispersion
into the water could be siphoned off, shark cannibalism would not occur.
The shark, evidently, is indifferent to the atypicality or injury as such.
In a word, the belief that lower life forms defile their disabled cannot
be accepted as even a rough approximation.
ATYPICAL PHYSIQUE IN PRIMITIVE
AND NONOCCIDENTAL SOCIETIES
Just as there is a belief that "human nature" is basically "animal
nature," so there is a feeling that what occurs among primitive societies
is really the primeval and true nature of man, which is only repressed or
camouflaged by the superficial niceties and hypocrisies of civilization.
Though such reasoning is questionable, anthropological horizons certainly
broaden perspective, especially in replacing an ethnocentric point of view
by an awareness of the otherwise unimaginable variety in the ways of
man.
That Spartan rule is by no means universal in primitive societies is
clearly shown in Maisel's compilation of data on more than 50 tribes and
societies drawn from the Human Relations Area Files at Yale University
(1953: Appendix). This latter source is equivalent to an extensive survey
of anthropological literature, for the material collected in the Files was
culled from books, articles, and records of anthropologists and other
observers, abstracted, and classified so that it could be expediently used
in a variety of studies. A sampling of the material is provocative:
Among the Siriono Indians, sickness not infrequently leads to abandonment
and death.
254 Physical Disability — A Psychological Approach
In the Azande tribe, infanticide is not practiced. "Abnormal children are
never killed nor do they seem to lack the love of their parents."
"A supplementary fifth finger or first toe is surprisingly common amongst
these [Azande] savages who are usually proud of the addition. . . ."
Among the Navajo Indians, the ideals proscribe sadistic humor against
those with physical deviations but in practice "A great deal of enjoyment is
derived from commenting verbally or through pantomime on the personal
affictions, infirmities, and peculiarities" of others. Uncomplimentary nicknames
are not uncommon.
Among the Masai, misshapen and especially weakly children are killed im-
mediately after birth.
Among the Dieri, a tribe of Australian aborigines, "infanticide is frequent,
applying to the children of unmarried girls, and to deformed children."
Among the Chagga, an East African tribe, cripples were felt to satisfy evil
spirits, thereby making possible normality in others. Hence, they did not dare
to kill cripples (who included children with more or less than five fingers as
well as the seriously deformed).
Among the Creek Indians, where "old age is revered to excess," the aged
infirm were killed only out of humanitarian reasons, such as when they might
otherwise fall into enemy hands.
Among the Truk peoples of the East Central Carolines, only the healthy and
strong are esteemed. The deaf and dumb are called umes (crazy people). Old
people and the disabled are considered to be superfluous.
Among the Wogeo, a New Guinea tribe, children with obvious deformities
are buried alive at birth, but children crippled in later life are looked after
with loving care.
Among the Dahomeans of Western Africa, it is a singular fact that the state
constables are selected from deformed persons. Children bom with anomalous
physical characteristics are held to be under the guardianship of special super-
natural agents. Some of these children are destined to bring good luck, and the
fate of others must be determined by signs from the supernatural. They may
even be "ordered" to be abandoned at the river bank.
Among the Ponape of the Eastern Carolines, crippled and insane children
were treated like the normal children.
Among the Witoto Indians of the North West Amazons, the newborn infant
is submerged in the nearest stream, for "if the child was not strong enough to
survive it had better die." If the child becomes deformed later, the medicine
man declares that it was caused by some evil spirit and may work ill to the
tribe, making it necessary to dispose of the person.
Among the Jukun, a Sudanese Kingdom, deformed children are not allowed
to live, but are left to perish in the bush or in a cave, for it is believed that
such children are begotten by an evil spirit.
Among the Semang of the Malay Peninsula, the person looked upon as a sort
of chief to settle disputes and admonish if necessary was a severely crippled
man who could only move with the help of a long stick.
Among the Balinese, sexual relations with albinos, idiots, lepers, and in
general the sick and the deformed, are tabooed.
Attitudes Toward Persons with Atypical Physique 255
Among the Palaung, an Eastern Clan, "it is lucky to have extra fingers or
toes, and extremely lucky to be bom with a hare-lip."
Among the Sema Nagas "the killing of idiots and similarly deficient persons,
such as hunchbacks and deaf-mutes, is 'genna' (taboo)."
Among the Macri of New Zealand, deformed persons meet with little
sympathy and often receive a castigating nickname.
If positive and negative attitudes toward persons with disabilities prev-
alent among the tribes and societies summarized by Maisel were to be
tabulated, there is no doubt that negative attitudes would show a pre-
ponderance. But sheer frequency can have such diverse significance that
we can do little more than note it. For example, just because infanticide
is shocking even to the most objective occidental investigator, it is likely
to be recorded as an impressive fact, whereas a benign attitude to the
child with physical abnormalities is more likely to go unheeded.
Although the variety of ways in which deviant members of society are
looked upon and handled in different cultures is in itself striking, it would
be a mistake to conclude that "anything can happen." The role prescrip-
tions for the aged among different societies provide an apt illustration.
Though the diversity is great, a common principle emerges in the fact that
all societies, as far as is known, differentiate between old age in general
and the helpless state in which the individual is regarded as a sufferer and
social burden (Simmons, 1952:44).
Similarly, although attitudes toward physique vary among different
groups, it is more than likely that all societies place a value on "body-
beautiful" and "body-whole." We do know that what is defined as "body-
beautiful" and "body-whole" varies, however. Scarification among the
Dahomey and Ashanti and the artificially produced protruding Hps of
the Ubangi are looked upon with favor in these African tribes, whereas
in our society such characteristics are regarded as deformities. Circum-
cision in our society does not destroy the intactness of the body nor does
shaving the beard. Among sections of the Orient, on the other hand, "the
total absence of it [the beard], or a sparse and stinted sprinkling of hair
upon the chin is as great a deformity to the features as the want of a
nose would appear to us; . . ." (Hentig, 194 8a :7S).
Although one could add hundreds of examples showing differences
among cultures in evaluation of physical characteristics, one wonders if
there is not a core of physical attributes essential to the perception of
"body-whole" and "body-beautiful" in all societies. Is there any culture,
for example, in which the absence of legs at birth is considered beautiful
or does not destroy the intactness of the body?
It is also conceivable that the psychological significance of certain
physical functions is sufficiently imiform among the cultures of man to
256 Physical Disability — A Psychological Approach
establish common attitudes. Thus, in explaining what he considers to be
universal attitudes toward the blmd, namely that the blind are both saints
and sinners, pariahs and prophets, Blank calls attention to "the importance
of vision in early psychosexual and ego development, and the existence in
practically everyone of unresolved conflict over scoptophilia [pleasure
from looking at] and exihibitionism" (Blank, 1957:1).
Until there is more abundant anthropological research on the attitudes
of different cultural groups toward physique and physical deviation, we
can only hazard the guess that though the variation in attitudes is greater
than we imagine, out of all the diversity will emerge psychological laws
that will contribute to our understanding of the fundamental character-
istics of attitudes toward physique. The following sections present several
attempts to specify fundamental conditions that would or at least might
have cross-cultural application in affecting attitudes toward disability.
REQUIREDNESS IN CAUSE-EFFECT RELATIONS
One might think that because attitudes toward physique vary con-
siderably from culture to culture, they are simply absorbed by the person
through repeated exposure to them without consideration of their sense.
This is not the case. Attitudes and behavior toward physical deviation are
tenaciously held and transmitted to the young as much because they are
felt to fit with sound and comprehensible beliefs as because of less clear
emotional prejudices.
In this section, we shall examine beliefs concerning physical disability
from the point of view of the perception of causes and effects of physical
disability. We shall try to explain certain characteristics of these a priori
connections and to show how they relate to attitudes toward disability. -
Let us consider an example from the neighboring field of emotional
disability. Until modern times the cause of derangement was viewed in
terms of the occult. Such an association, foolish as it seems to us now,
had a firm psychological basis. Where knowledge is lacking, primitive
thinking connects the strange and inexplicable behavior of the insane with
a strange and inexplicable cause, the occult.
In short, there is a similarity in the structure or quality of the effect and
its perceived cause, just as the imprint in the sand (effect) fits the shape of
the foot that formed it (Scheerer, 7954.103-104). As has been amply
demonstrated in the laboratory, similarity is one factor in perceiving visual
stimuli as unified figures (Kohler, 1947). Heider has extended this princi-
- Gestalt psychologists have emphasized the study of the perception of cause-
effect connections and refer to it as the problem of phenomenal causality. See
Dunckcr, 1945; Heider, 1944; Kohler, 1947; Scheerer, 1954).
Attitudes Toward Persons with Atypical Physique 257
pie by pointing out that "in general one may say that factors making for
figural unit formation also make for causal integration" {1944:362).
Perceiving the cause of insanity in terms of witches and demons, society
reacted accordingly. The beating and burning of emotionally disturbed
persons were seen as neither unjust nor irrational. They were, rather, reac-
tions that were appropriate to the perceived cause.
As science advanced the theory of mental illness, however, the former
treatment became abhorrent because it clashed with the new understand-
ing concerning cause of the disorder. At least certain attitudes and be-
havior toward disability, then, are not willy-nilly affairs that arise and
change as fashion dictates. Rather, their underpinnings are solidly fastened
to perceived cause-effect relationships.
Some enlightening aspects of perceived causal sequence especially
significant in attitudes toward disability appear when we examine attitudes
toward health as a value. In an experiment in which subjects were asked
to make seven wishes for their fantasied new baby, four out of five
subjects mentioned good health (Dembo, 1953a). Good health is so
prized that we spend untold millions of dollars in advertisements, educa-
tion, and medical care, and even this is insuflBcient for the achievement
of the optimal health of the nation. At an early age children are taught to
brush their teeth and admonished to develop strong and healthy bodies.
Surely not a day goes by for many children that health facts are not
stressed in one form or another — at mealtime, at bedtime, at playtime.
At first the child may recognize the value of health as something unto
itself, something to be guarded and cherished. This gradually receives the
necessary support in the intelligible connection between health and posi-
tive consequences. He soon discovers that when he is healthy and can run
and play he feels well, and when he is ill he suffers distress and must stay
in bed. The endless assertions that make health the royal road to success
strengthen the logic of this connection. Advertisements tell him that a
certain dentifrice will make his breath kissing sweet and implies a blissful
marriage. Parents and teachers tell him that his grades will improve with
more adequate rest, and so on. (Ellis presents a lively account of the
beatification of beauty, 1954: Chap I.)
Not only does health become a highly valued goal and illness a dis-
agreeable state, but the conditions that bring them about — i.e., their
causes — become invested with befitting moral qualities. If the state is a
negative one. its cause must be negative also. Thus, the child comes to
feel that illness is a punishment for his transgressions. Two factors con-
tributing to his perception may be distinguished. The first is his social and
personal experience. He is often threatened with illness as the price for
infringement of health rules. If he goes out without his rubbers, he is told
that he will catch a cold. If he eats too much candy, he will get holes in
258 Physical Disability — A Psychological Approach
his teeth. If he goes to bed too late, he will stop growing. Some of these
rules are based on scientific fact, and others are myths and fancy. He also
accumulates sufficient evidence to back up the connection between illness
and punishment in his own eyes. He remembers, for example, the day he
ate quantities of sweets and writhed in agony as a result.
Secondly, the felt appropriateness between illness and sin may well
represent an emotional syllogism, a term first introduced by Franz Alex-
ander to describe the elementary emotional sequences and connections in
man (1938). That suffering is caused by evil appears to be grasped with-
out additional argument. No elaboration is required for its comprehension.
In the words of Heider, "a state of harmony or balance exists if entities
which belong together are all positive, or if they are all negative" (1958:
Chap. VII).
The person may ascribe the source of suffering to wrongdoing in him-
self or in someone else, but in any case the source is one of evil. We have
seen how the person himself may feel he has sinned. In asking the seem-
ingly naive question that often besets a person who has suffered a dis-
ability or a deep loss: "Why did this have to happen to me?" is he not
in some obscure way searching for a personal offense that might justify
his hurt? A slight change in the question, to "Why did this happen?"
represents a major change in the meaning of the disability, a change in
which objective nonpersonal attribution is uppermost and guilt is less
apparent. In other instances the source of the affliction may be attributed
to the negligence of a second person, in which case it is often felt as
willful negligence even though objective consideration may deny premedi-
tation. Imputing an intention augments the sin to a level appropriate to
the disastrous consequence.
Thus, hardly a parent of a child who has a disability can escape the
conviction that in some way avoidable mismanagement was a contributing
cause if not the cause of the disability. The mother may blame herself or
her doctor for the sedation that might have caused the birth injury of her
child. Someone has to be blamed, for disability is perceived as having its
source in wrongdoing. This is brought out in a study of the attitudes of
parents of blind children (Sommers, 1944). On the basis of interviews
with the mothers, the investigator distinguished four attitudes toward
blindness :
Blindness as a symbol of punishment: "What have we done that God should
wish this on us?"
Fear of being suspected of having a social disease: "I am sure the neighbors
say this about me because they have mentioned it in reference to other handi-
capped children in the vicinity."
Attitudes Toward Persons with Atypical Physique 259
Feelings of guilt due to transgression of the moral or social code or to negli-
gence: "I blame myself for not having had a doctor."
Blindness as a personal disgrace to the parents: "Our family felt it was a
disgrace and were ashamed."
There is other evidence that disability and illness are linked to causes
of a negative, evil signification. To the ancient Hebrews, illness and physi-
cal defect marked the person as a sinner. Twelve blemishes are enumer-
ated in the Bible that disqualified a priest from officiating. Among those
mentioned are "a blind man, or a lame, or he that hath a flat nose, or
anything superfluous, or a man that is brokenfooted, or brokenhanded, or
crookbackt, or a dwarf, or that hath a blemish in his eye, or be scurvy,
or scabbed, or hath his bones broken . . ." (Hentig, 1948a:16). Gradu-
ally other bodily imperfections were added, of which the later Talmudists
mention no less than 142. A Roman priest also had to be free from
physical infirmities, and the same rules apply to the Catholic priest to
this day (Hentig, 1948a). It was a strict commandment of the Old Testa-
ment that "The blind and the lame shall not come into the house." Illness
was considered both a punishment and a means of atonement. Children
in occidental cultures frequently regard their illness or disability as a
punishment for personal sins and after frequent bouts with illness or
continuing disablement may feel that "it is someone else's turn"; they have
paid their debt.
In some societies, as among the Trobriand Islanders, the affliction is
blamed on an enemy thought to have caused it through sorcery (Hanks
and Hanks, 1948). It has been noted that the term "ugly" in its aesthetic
sense was preceded by a moral significance. It is derived from a root
meaning "dreadful, fearful." In connection with weather, it means
"threatening" (Hentig, 1948a:6A). We also note the equivocal meaning of
such allusions as "his bad leg," "my bum arm," the child who is not "quite
right." Hentig goes so far as to say that all peoples have had the idea
that physical defect and punishment for some sort of wrong, committed
perhaps by an ancestor, were somehow connected il948a:ll). This feel-
ing is difficult to dislodge because of the cognitive limpidity with which
it is grasped. It may be one reason why the theory of compensation as
indemnity (see pp. 49-51) has so firm a hold on the minds of experts
and laymen alike; the wrong is righted through compensation.
Moreover, it seems that human beings feel that suffering as such should
be reserved as a punishment for evil. Our sense of justice requires this.
We inveigh against events that bring suffering to the innocent. War
becomes all the more reprehensible when we think of the children who
become its innocent victims. In the same way we feel that we should
260 Physical Disability — A Psychological Approach
deserve the rewards we get (Asch, 1952; Heider, 1958). Somehow virtue
and reward go hand in hand as do evil and punishment or suffering.
The concept of suffering as rooted in virtue does not easily emerge as a
self-understood connection. In order for it to become so, other purposes
tend to be introduced. For example, one may conceive of suffering as a
test for lofty future roles or as a means to attaining deep understanding
(see pp. 78-82), or as a consequence of self-sacrifice in the interests
of higher purposes. Thus, there are cripples among the gods; in the Nordic
mythology, Wieland, god of smithery, was lame (Hentig, 1948a:lA). The
Christian doctrine introduced the view that disease may be a means of
purification and a way of grace. Where suffering stems from good, good
must be its product. The suffering cannot be for naught. 'That they shall
not have died in vain" carries with it tremendous force just because the
harmonious emotional sequence is threatened. On the other hand, where
suffering stems from evil, it is sufficient unto itself. The matter can simply
rest there. The a priori connections are complete. Evidently, the quality
and nature of suffering and of evil are more compatible than those of
suffering and virtue. Cross-cultural reference should, therefore, find fre-
quent evidence of the former association, and of the latter only when
elaboration leads to the necessary congruence.
Not only is the source of illness and disability seen to lie in evil and
sin, but where there are further effects, the consequences often are also
felt to be sinful. "A twisted mind in a twisted body" captures this devalua-
tion of the total person. In Chapters 5 and 6 some of the conditions
responsible for the negative spread from disability to other characteristics
of the person have been discussed. Here it is sufficient to note that there
appears to be a strong cognitive factor that makes for the seeming appro-
priateness between disability as an unwelcome state and its negative
effects.
Illustrative are the following statements given by patients with facial
disfigurements. They express fear of having negative character traits
imputed to them because of their deformities (Macgregor, et ah, 1953:
70-71). A patient with a grossly disfigured face resulting from war
injuries recounted, "When I parked my car in front of a jewelry store,
two cops came up and asked me for my identification card. They thought
I was a gangster." A patient with harelip and cleft palate told how "chil-
dren would make fun of the way I talked and looked and said I wasn't
normal." That evil acts are associated with marked physical deviation has
been shown in an experiment in which nondisfigured persons reacted to
the photographs of persons with facial anomalies (Macgregor, et ah,
J953). One photograph showed a 30-year-old man who had a low,
Attitudes Toward Persons with Atypical Physique 261
Darrow forehead, a prominent, convex nose, a receding, pointed chin,
narrow, deep-set eyes, large buck teeth, and lop ears. The fact that he had
superior intelligence and earned a good salary as a junior executive in
a chemical corporation was not mentioned. The following conclusions
were drawn about him: "He is mean and small — not bright. He might be
a follower in a gang. He's a dope addict. Man seems to look like a
maniac. Has desire to kill" (p. 77). The investigators conclude that
"facial features which served as false clues led respondents not only to
impute to these patients personality traits considered socially unacceptable
but to assign them roles and statuses on an inferior social level" (p. 79).
Meng, a Freudian, has stated that the nondisabled unconsciously believe
that the cripple has committed some evil act and is therefore dangerous;
or, if he has not committed an evil act, that he will do something wrong
in order to warrant his punishment (1938, reported in Barker, et al.,
1953:81). Thus, with illness and disability both the perceived cause and
the perceived effects often match the negative qualities of illness and dis-
ability. Moreover, the cause-effect relationships often have a moral refer-
ence. An Italian proverb records that "The squint-eyed are on all sides
accursed" (Hentig, 1948a:94).
Lest there be a too hasty overgeneralization, however, we should note
again that a substantial number of people connect suffering or even
tragedy with such positive effects as deeper understanding and higher
values (see pp. 78-82), It seems likely that the connection in these
instances is not made immediately but is rather built up through a com-
plex of cause-effect relationships.
In conclusion, to affect attitudes toward disability in more positively
adjustive directions, one must give substantial weight to factors determin-
ing phenomenal causality. It is in the nature of human beings to search for
reasons and answers. We need to know, and where knowledge is lacking,
we still try to make sense out of the course of events. And the sense that
makes one kind of sense, in the absence of fact, is to link disability as a
consequence and producer of error and evil. The sense that is both more
adjustive and more scientific views disability as a physical fact which,
being neutral, does not lend itself to concepts of evil, punishment, and
sin. For example, the statement of former times that the cause of squint
resides in an evil disposition immediately sounds absurd when one regards
a squint as a physical condition of the musculature of the eye. Moreover,
when one views physical disability as a physical fact, any psychological
cause-effect relationships are not immediately perceived because of neces-
sity but require psychosomatic and somatopsychological theory and in-
vestigation to establish them.
262 Physical Disability — A Psychological Approach
THE DIFFERENT AND STRANGE
*To be different" is to be "set apart," which, in the language of inter-
personal relations, may signify rejection. During adolescence, for example,
conformity in every respect to the ways of the peer group receives startling
obeisance simply because "belonging" is highly valued. Many writers
have also attributed the rejection of a person with a disability to the fact
that he is different. "No one wants to be different" is accepted as an
obvious law of man.
In his balance theory of sentiments, Heider (1958) gives firm support
to man's negative reaction to the different and strange. Stated briefly, this
theory posits an interdependence between a person's liking for another
(sentiment relation) and the connection of belongingness (unit relation)
he perceives with that person. There are many factors that give rise to the
feeling that two persons form a unit — that is, that they belong together in
some way. These are called unit-forming factors. For example, two
persons may be associated together through kinship; through similarity of
beliefs, nationality, and religion; through familiarity and interaction, etc.
The idea is that when person p identifies with another person o because of
any one of the unit-forming factors, a tendency for p to like o will be
induced. The inverse relation also holds: if p likes o, a tendency to per-
ceive similarities between them will arise. Parenthetically it may be noted
that the concept of unit-forming factors had been systemically investigated
by Gestalt psychologists who demonstrated their importance in percep-
tion. Heider incorporated the concept within a theory of sentiments,
adding such peculiarly human imit-forming factors as similarity of beliefs,
the strong connection between a man and his deeds, and between a man
and his property (ownership).
In Heider's work, many examples are given from research and every-
day life of a relationship between liking and similarity between individuals.
Thus it is noted that the point of many proverbs is that similar indi-
viduals tend to associate and to like each other. In an experiment on
social relationships, it was shown that the subjects perceived persons they
liked best as more similar to themselves than those they liked least
(Fiedler, Warrington, and Blaisdell, 1952). Familiarity has also been
demonstrated to give rise, at least under certain conditions, to a positive
affinity of p for o.
The opposite cases of these factors — namely the effects of dissimilarity
and unfamiliarity — have direct bearing upon attitudes toward disability.
Heider's theory postulates that there will be a tendency for the dissimilar
and strange to evoke a negative affection in p for o. An example presented
is that of xenophobia, where the hesitancy in befriending a foreigner is
Attitudes Toward Persons with Atypical Physique 263
accounted for by the dislike induced by the dissimilarity and perhaps also
unfamiliarity of the alien member. Specifically dealing with attitudes
toward crippling in the light of the different and strange is the work of
Winkler {1931), reported earlier on p. 124. He accounts for the fact that
negative reactions to children who were crippled but not consciously
recognized as such occurred more frequently than toward healthy children
by the hypothesis that there is little possibility that physically normal
individuals can establish an empathic relationship with the crippled
because of their unusual postures and movements.
Heider attributes the negative effects of unfamiliarity to at least two
factors. The first has already been discussed in regard to imcertainty
engendered by new situations (see pp. 99-104) : that is, an unfamiliar
situation is cognitively unstructured. It is full of possibilities that may be
sufficiently threatening to an insecure person to make him withdraw from
it. Conflict and unstable behavior result. The second factor is a more
purely intellectual and aesthetic component of the resistance to the un-
familiar. "The strange is experienced as not fitting the structure of the
matrix of the life space, as not fitting one's expectations. The adaptation
or change in expectations which is required by meeting the unfamiliar
demands energy. It is more comfortable to wear old clothes and to talk
with old friends" (Heider, 1958:\9A).
Actually, the evidence that similarity and familiarity induce liking is
much more consistent than that dissimilarity and unfamiliarity induce
disliking. Heider, on the basis of work stemming from his theory (Cart-
wright and Harary, 1956), raises the possibility that whereas similarity
and familiarity may lead to a real feeling of unity between p and o, dis-
similarity and unfamiliarity may not necessarily lead to disunity, but
rather to a mere absence of the unit relation in some cases. Resistance
against being grouped together might be taken as one of the criteria for
real disunity. The conditions underlying the two states of absence of a unit
relation and its disjunction are not yet clear. Here research is sorely
needed. We need to know much more about the nature of differences and
unfamUiarities as well as the conditions surrounding them that evoke
indifference on the one hand and withdrawal on the other. In any case, as
applied to disability the distinction between absence of a unit relation and
its disjunction means that a person with a disability need not necessarily
be seen as separated from the able-bodied by an unbridgeable chasm.
Moreover, Heider himself is careful to point out that there are many
instances where the unfamiliar and the different have their own allure,
and that under some conditions similarity and familiarity, instead of
inducing liking, give rise to disinterest and disliking.
It is clear that the influence of similarity and familiarity on sentiment
is not a simple one and, particularly in combination with other factors.
264 Physical Disability — A Psychological Approach
may have diverse effects. Nevertheless, Heider's theory and the evidence
in support of it do make it necessary to conclude that a person who is
clearly set apart because of an atypical physique may by this very fact
experience a certain emotional distance if not pronounced antipathy from
others who regard him only in terms of this deviation.
The theoretical formulations of other investigators also can be drawn
upon in the search for understanding of the negative reaction to the dif-
ferent and strange. In terms of the concept of body image as developed
by Schilder {1935), for example, the other person's physical difference
creates uneasiness because it does not fit with a well-ordered body image.
Moreover, a person's unconscious body image of himself may be
threatened by the appearance of a person with a missing part or de-
formity, inasmuch as he identifies to some extent with that person.
A neurophysiological theory to account for the fear response to the
strange has been proposed by Hebb {1946), based upon observations that
both man and chimpanzee show spontaneous fears of mutilated and
unresponsive bodies (e.g., dead or anesthetized bodies). The statement of
the theory that applies most particularly to reaction to disability is that
"fear occurs when an object is seen which is like familiar objects in
enough respects to arouse habitual processes of perception, but in other
respects arouses incompatible processes" (p. 268). More broadly, the
theory is one of disruption of the pattern of existing internal neuro-
physiological activity, especially that of cerebral events, which disruption
may occur through different classifications of fear-invoking situations.
Fears of mutilated and strange bodies are due to conflict, inasmuch as
they arouse both usual and incompatible perceptions and intellections.
Another source of fear is sensory deficit, as in darkness or loss of support,
in which case the withdrawal of sensory stimulation disrupts the habitual
modes of cerebral action.
The preceding discussion suggests certain measures in the interest of
enhancing adjustive attitudes toward disability on the part of the com-
munity at large. It argues for the integration of children with disabilities
into the regular schools wherever feasible, rather than the establishment
of special schools, so that familiarity with physical deviation may take
place in natural settings. It also calls attention to the proposition that it
is less the physical deviation as such that creates a feeling of being dif-
ferent than the psychological characteristics imputed to the person
through the phenomenon of spread (see pp. 118-128). This means that
education to the effect that physical anomaly does not betray personality
is of the first importance. All one knows about a person with a disability
is that he has the disability. Until one knows more about him, one can
hardly say more. Once spread has been held in check, physical dis-
similarity may become a relatively minor feature among the welter of
Attitudes Toward Persons with Atypical Physique 265
other characteristics that unite people. In short, rather than as a disabled
person, he can be perceived as a person with a disability. The disability
then makes less of a difference as far as unit formation is concerned, to
use Heider's theoretical formulation. After all, the person with a disability
is first of all a person, and as such already bears essential samenesses with
the person observing or interacting with him. This point is one of the
crucial elements of what is referred to as the "brotherhood of man."
CHILDHOOD EXPERIENCES
To the extent that attitudes are "made" and not inborn, their seeds may
well be sown during the years of early childhood. But sown in what way?
Direct plantings of attitudes toward disability and deviation are clearly
significant.
As illustrative, the following account was selected for several reasons.
It presents a naturally occurring incident in the life of an ordinary child
in our own culture. It deals directly with the problem of individual dif-
ferences in an aspect of physique not involving disability as such. It
portrays positive influences on attitudes toward deviation, an emphasis we
would like to underscore in the face of the variety of conditions under-
lying negative attitudes that have already been discussed.
Cathy is an 8-year-old child, somewhat above average in height, plump
but not fat. She, however, feels that she is fat, and intermittently becomes
somber and disturbed about this. The fact that she has beautiful, large
blue eyes that have very often been commented upon may have over-
stressed the value of appearance to her, leading to an oversensitivity
about body proportions and other physical characteristics.
SCENE i: Cathy has just returned from visiting Mary, an 8-year-old friend
who is very slim.
Cathy (somberly) : Mommy, why am I so wide?
Mother: You are not so wide. But some people are wider and some people
are narrower.
Cathy: But why don't Mary's clothes fit me?
Mother: Well, people are different sizes. Mary is a very slim girl.
Cathy (explosively) : But I don't want to be fat!
Mother: I don't think you are too fat. Isn't it interesting that every child
seems to find something about himself that he doesn't like? Either he is too
thin or too fat, or his hair is too straight or too curly, or he thinks he can't
run fast enough, or his eyes are too small, or something.
Cathy (with a somewhat lighter heart) : Well, I have two things about myself
that I don't like. I am too fat and I wish I didn't have these freckles on my
face.
266 Physical Disability — A Psychological Approach
Mother: Those freckles can't come oflf, Cathy, so don't keep rubbing at them.
Those freckles are a part of you, and I love them because you're my little
girl. Why, if you came down without those freckles, I'd say, "Where is my
little girl?"
Cathy (laughing with relief) : What about yourself don't you like, Mommy?
Mother: Oh, now I'm not really bothered about anything like that.
Cathy: But what about yourself don't you like now?
Mother: Now I'm not bothered about anything Uke that. But when I was a
little girl I used to think that my teeth were too crooked and my legs were
too bow-legged.
Cathy: But your teeth aren't too crooked.
Mother: I know, but I sure thought they were. I used to mope about being
bothered. But now I just know that these things don't really matter. Why,
this world has room for all kinds of people — for big people, and little people,
for fat people and thin people, for people who are very pretty, and for
people who are not.
Cathy (pausing) : For people with different colored skin and different kinds
of eyes.
Mother: Right. For loads and loads of different kinds of differences.
(Brother enters and conversation shifts.)
scene n: The next morning at breakfast Cathy has filled a bowl of cereal.
Cathy: Mother, may I have this banana?
Mother: You already have one.
Cathy: I only have half in my cereal because I ate the other half.
Mother: O.K.
Cathy: I don't care if I'm fat as long as I'm your little girl (rather gaily).
SCENE ra: Several days later at dinner (Edward is Cathy's brother).
Cathy: Why am I getting wider over here? (pointing to her hips, somewhat
furtively)
Mother: You're not getting too wide. But you're growing up and that's why
you're getting wider in the hips.
Edward: Boys get wide hips too.
Cathy (matter-of-factly) : But not as wide as girls.
Edward (challengingly) : Oh, yes they do.
Mother: As boys and girls grow older, they get wider and taller all over.
But girls have wider hips because they need more room there when they
become mommies.
Cathy (seriously, but not solemnly): Rita's grandmother has very wide hips.
They stick out like that (extending her arms broadly on each side). But that
doesn't matter, because she is a very kind woman. (On previous occasions,
the mother reports that whenever discussions arose concerning race differ-
ences or physical deviation, she stressed that the kind of person you are is
what counts, rather than such surface characteristics as color of skin, or
whether you limped, which told nothing at all about the person himself.)
Attitudes Toward Persons with Atypical Physique 267
SCENE rv: One month later. Cathy is getting ready for a birthday party.
Cathy (firmly): I don't want to wear this dress because it makes me look
too fat.
Mother: You are not too fat. You only think you are.
Cathy (crying) : Oh, yes I am. You only say that to make me feel good. I
won't wear it! (angrily throwing the dress on the floor)
Mother: That's all right. You can wear another dress that you like better.
SCENE v: Several months later.
Cathy: Oh, I wish I didn't like to eat so much.
Mother: Why?
Cathy (good-naturedly) : Because then I wouldn't be so fat, silly.
Mother: The trouble is that food tastes so good.
Cathy: They should have made it so it didn't.
Mother: Convenient, eh?
Cathy (laughing) : Yeah. Oh well (takes another bun).
There is much in this sequence that would seem to influence more or
less directly Cathy's attitudes toward disability. The general observation
that Cathy's feelings about obesity fluctuated is interesting. This is often
true of the process of attitude change. Adjustment seesaws because the
required reorganization of one's system of values does not occur as a
smooth, unidirectional pattern. For example, in situations evoking intel-
lectual discourse, one might reach out toward adjustive understanding,
but unless emotional acceptance supports these realizations, one may well
slip back in situations that arouse feelings uncontrolled by conscious
consideration. Thus, in the first three scenes Cathy was able to go rather
far in viewing physique as a difference but not all the difference, whereas
in the fourth scene, when she was all keyed up toward matters of appear-
ance in anticipation of a party, she again became disturbed. Nevertheless,
intellectual change is important, not only because it is conducive to ade-
quate behavior in more rational situations but also because the intellectual
and emotional levels are interdependent. Intellectual understanding may
encourage emotional acceptance by helping shape events conducive to
alteration of feelings; conversely, emotional changes affect intellectual
conclusions (see Chap. 7).
Although Cathy will continue to struggle with her evaluation of obesity
and the acceptance of herself, the new understandings that she already
had begun to grasp will serve her well. Note how in the first scene Cathy
at first substituted the less appropriate word "wide" for "fat." At that
time obesity seemed to pervade her entire psychological world; it was
ubiquitous and crucial. She was helped when she learned that she did not
stand alone in her disturbing feelings, that other children also were dis-
satisfied with something about themselves. She needed the further support
of believing that her mother too had lacks. Perhaps her mother would
268 Physical Disability — A Psychological Approach
have been wiser to have given the child this reassurance instead of denying
that anything bothered her now. Had she acknowledged some imperfection
— a double chin or anything else — in a free and easy way, she would
have conveyed the understanding that one can feel all right about a defect
without denying or concealing it. Again in the fourth scene the mother
tried to deny the cause of Cathy's concern: "You are not too fat. You
only think you are." Though objectively the mother was right, this ap-
proach could not give Cathy a comfortable feeling about herself as long
as she was convinced of the contrary.
An important realization grew out of the interchange in Scene I when
the mother told the child in effect that she loved her because of herself
and that having certain physical characteristics did not detract from that
love. The mother sensitively imbedded Cathy's anxiety in a somewhat
more lighthearted and easily manageable emotional framework when
she said, "Why, if you came down without those freckles I'd say, 'Where
is my little girl?' " Further basic understandings pinpointed in these scenes
are that there are "loads of different kinds of differences," that the world
has room for most of them, and that other things matter more than
physique — "her hips stick out like that but that doesn't matter because
she is a very kind woman."^
A direct attempt to influence attitudes toward persons with disabilities,
an attempt on the wide scale of public school education, is provided in a
discussion and set of instructions for classroom teachers as to how they
might help boys and girls at the fourth-, fifth-, and sixth-grade levels
reevaluate their feelings toward children with various kinds of disabilities
{Understanding the disabled, 1956). Briefly, the instructions include:
1. Use of a social distance scale technique to indicate the feelings of the chil-
dren about boys and girls with various kinds of disabilities as portrayed in
pictures.
2. Discussion of the children's ratings on the social distance scale.
3. Discussion with the children of stereotyped statements about people with
disabilities, such as "I feel I should be especially friendly to people like that"
or "A person like that can't do the things other people do."
4. Seeking further information by arranging discussion with local physicians
and nurses, and if possible with an employer who welcomes employees with
handicaps, contacting national and local disability organizations, and review-
ing the lives of individuals who coped successfully with their disabilities.
5. Completion of a picture story involving a boy with a disability in order that
the children may apply the knowledge and constructive attitudes which it is
3 An enlightening account of effecting adjustive attitudes toward disability
through role playing in the home appears in a paper by Rosemary Lippitt
{1947) and is reported on pp. 247-248 of the present volume.
Attitudes Toward Persons with Atypical Physique 269
hoped have been accrued in some measure through the preceding activities.
The stories are then acted out.
6. Discussion of an incident involving a girl with a disabiUty in order to give
the class an opportunity to evaluate the attitudes of someone else toward a
person with a disability.
The lesson plans, based on sound psychological principles, provide a
clear and encouraging guide for the teacher but allov^^ her flexibility in
taking into account her own feelings and judgments about her specific
classroom situation. Moreover, the instruction booklet can be used to
excellent advantage with other groups as well, notably parents of children
with or without disabilities, and children with disabilities themselves for
modifications of procedure to fit special conditions and purposes can
readily be made.
Many experiences that influence attitudes toward disability need not
involve the verbal expression of attitudes. Feelings and beliefs are trans-
mitted— sometimes vaguely, sometimes precisely — by actions as well as
words. When a child sees someone condescendingly toss a dime into the
cap of a beggar, he is learning something. When the child sees a child
with a disabled foot participating in the classroom, he is learning some-
thing. Such experiences, whether verbal or behavioral, can be crucial in
the development of attitudes toward disability.
There is some evidence that attitudes toward disability are also condi-
tioned by child-rearing practices seemingly unconnected with disability
as such. This has been most clearly shown in the work of Whiting and
Child (1953), who investigated the effects of socialization methods in
child training by analyzing material in the aforementioned Human Rela-
tions Area Files.
Particularly relevant to our interest are the findings concerning the
relation between theories held in the culture to account for illness and
the severity of socialization practices devised to teach children to conform
to adult standards. Since the results deal with attitudes toward illness,
they may be presumed to be applicable to attitudes toward disability as
well. Beliefs about illness were selected as potential reflectors of child-
rearing practices inasmuch as most primitive cultures lack the scientific
knowledge for basing their beliefs on reality. The particular areas of
child development that were rated for severity of socialization promised
to be of special significance according to psychoanalytic theory and
included the following areas: oral, anal, genital, aggressive, and de-
pendent.
One of the hypotheses borne out by the study was that those areas of
child development which are severely socialized would create anxiety
and therefore would be expected to be incorporated in the theories of
270 Physical Disability — A Psychological Approach
illness in the society. For example, there were 23 societies with an oral
theory of illness (e.g., illness is caused by eating something) and 16
societies without such an explanation. The average severity of weaning in
the first group was 12.22 on a scale from 0 to 20, and in the second only
8.94, a difference that is highly significant statistically. In our society,
middle-class practices concerning oral training are rated by Whiting and
Child toward the severe end, a rating consistent with the prevalence of all
sorts of oral theories of illness among this group. The results for the other
areas of behavior are not as clear, but they are in the same direction.
It is worthy of note that these findings are consistent with the theory of
requiredness in cause-effect relations discussed earlier (pp. 256—261).
That is, illness is a negative state. As such its cause is sought in factors
that also are negative — in the case at hand by virtue of their anxiety-laden
character.
With respect to overcoming illness, Whiting and Child had expected
that the therapeutic practices would show some connection with behavior
that in childhood had been satisfying through a long period of indulgence
on the part of adults. The findings were generally negative except for the
sexual area of development. In only two cultures were sexual practices
believed to have a specific therapeutic value; in these two societies there
is a very high indulgence of childhood sexuality.
Another aspect of theories of illness studied was that of guilt. Guilt
was indicated by the belief that the patient is responsible for his illness,
as contrasted with attribution to accident or some outside agent. The
hypothesis that societies with the severest socialization practices would
create the most anxiety and guilt, and therefore would tend to impute
responsibility for illness to the patient, was supported. Since the overall
severity of socialization as evidenced in the middle class of our society
was rated close to the top of the 51 cultures examined by Whiting and
Child, it is not surprising that in this culture we commonly find attitudes
of guilt associated with disability, specifically that disability is meted out
as punishment.
A second hypothesis involving guilt was also supported, namely, that
societies using loss of love as a threat to induce conforming behavior in
the child should tend to have higher ratings on the acceptance of patient
responsibility for illness. This hypothesis was based on a theory that guilt
is due to anxiety over the loss of love of the person on whom the child is
dependent.
The most general conclusion of the Whiting and Child study relevant to
disability is that beliefs about illness are indirectly influenced by those
significant early relations between child and parent that have to do with
the child's conformity to adult standards of behavior. The study provides
a good example of how theory — in this case a theory of the important
Attitudes Toward Persons with Atypical Physique 271
phases in child development and the conditions of learning that surround
them — can produce new knowledge and understanding.
In any discussion of the significance of childhood experiences, psy-
choanalytic theory has an important place. Because many good accounts
of the psychoanalytic viewpoint are available (e.g., Thompson, 1950),
we shall not review the theoretical framework here. Of the many facets of
psychoanalysis, however, castration theory is directly related to emotional
disturbance occasioned by the sight or thought of disability. A summary
of it follows:
In brief, the castration complex comes about as a result of childhood ex-
perience. The child soon discovers the meaning of his genital organs and, in his
earliest fantasies revolving about the love of the mother, unconsciously "posits"
his penis as a rival to his father's. Fearing revenge from the father, however,
the child imagines that retribution will take the form of depriving him of his
male organ. Such a drastic procedure would, in his fantasy, be the only
appropriate punishment from the father for taboo Oedipal desires in which the
mother becomes an incestuous love object. Throughout his childhood, the child
may extend these vague fears to encompass the notion that his father will, in
one way or another, punish him for his sexual activities in general. Thus his
remorse or anxieties about masturbation may be reflecting castratory fears.
The castration complex could, according to psychoanalytic thought, be
symbolically brought into play by any remotely analogous equivalent of castra-
tion. Thus the loss of a leg, or seeing another person who has lost a leg, may
stir up archaic castratory fears. Indeed, the loss of any part of the body, or the
sight of such a loss, is said to be symboUcally capable of recalling the Oedipal
taboo and the father's potential revenge — that of cutting off or mutilating the
phallus.
But could such a theoretical explanation offer a possible reason for women's
reactions to disability as well? Yes, according to Freudian theory, even though
women have no phallus to fear losing. For while the little boy is going through
the Oedipal phase, with its taboo complications, phallus fantasies and fears, and
rivalry with the father, the little girl is also experiencing incestuous desires.
Indeed, she goes through two phases. Unlike her brother, who experiences only
a mother fixation, and is never sexually attracted to his father, the girl child
may first have a mother attachment, a survival of the oral (breast-feeding)
phases of her existence. This leads her to an identification with the father, just
as the boy identifies himself with his father as a rival for his mother's affections.
The girl, however, discovers the difference between the sexes at an early age,
and her own absence of a penis gives her a castration complex — ^she feels that
she has been deprived of the male organ, and suffers a deep sense of loss. No
longer able to rival her father, she then identifies with her mother, and makes a
fantasy bid for the father's love. As opposed to the boy child's Oedipal-
castratory development, the girl child passes through a phase in which the
Electra complex (fixation on the father) and the castration complex are major
experiences [Maisel, 7955.55 1-553].
272 Physical Disability — A Psychological Approach
Whether or not castration anxiety is universal, and whether or not it
necessarily has such ubiquitous effects where it does exist, are matters
for conjecture and research. In any case, the clinical evidence is strong
that castration anxiety does occur and can ramify to attitudes toward dis-
ability. The psychoanalytic viewpoint, insofar as it posits universal and
far-reaching castration anxieties, leads to the conclusion that negative
attitudes toward persons with disabilities are inevitable though, to be sure,
they may be ameliorated through education and certainly through psycho-
therapy. The essential therapeutic process would seem to require either an
elimination of castration fears or a separation of body deviations from
meanings linked with the family triangle (the child's love for one of the
parents in competition with the other) .
Although early childhood experiences that have no direct connection
with attitudes toward disability have a great deal of potency in determin-
ing those attitudes, it is undoubtedly also true that experiences directly
involving deviancy of all sorts, illness and disability, leave their mark.
Attitudes to which the child is exposed in viewing minority groups, the
slow learner, his own shortcomings, and countless other differences cannot
be underrated.
SOCIOECONOMIC FACTORS
The conditions that give rise to and support cultural attitudes toward
physical disability have also been sought in the economic features of
society. Hanks and Hanks (1948) note that among the Greenland
Eskimos, where economic surplus is maintained at a very narrow margin,
the congenitally defective are often killed in infancy and those with
acquired handicaps are taken care of by the family until they are deemed
an economic liability, in which event they commit suicide or are
abandoned. In contrast is the different treatment of the handicapped by
the Northern Blackfoot of the North American plains and by certain
tribes in Melanesia, where the economy for the most part is adequate
and the society democratic. Here, the protective obligation of the family
toward the person afflicted is increased. Hanks and Hanks tentatively offer
the following propositions: Protection of the physically handicapped and
social participation for them are increased in societies in which ( 1 ) the
level of productivity is higher in proportion to the population and its
distribution more nearly equal, (2) competitive factors in individual or
group achievement are minimized, (3) the criteria of achievement are
less formally absolute, as in hierarchical social structures, and more
weighted with concern for individual capacity, as in democratic social
structures.
The role of economic factors in attitudes toward physique, an area
Attitudes Toward Persons with Atypical Physique 273
barren of research, promises to yield important data and insights. Knowl-
edge of these factors, however, is only part of the knowledge needed for
understanding the full significance of physique and physical deviation, for
otherwise greater consistency according to economic status should be ex-
pected than does in fact exist. The Hankses note, for example, that
although the Paiute of the Great Basin of North America had a margin of
existence almost as precarious as that of the Greenland Eskimos, infanti-
cide was not practiced and their disabled were not abandoned.
In addition to economic conditions, cultural theories as to the source
of disablement and its effects on the person doubtless play a role in the
treatment accorded to persons with disabilities. The Hindu theological
concept of Dharma, for example, explains an existing personal condition
as the inevitable result of past behavior in previous incarnations (Hanks
and Hanks, 1948). It is consequently reasonable that sympathy for
persons with defects is lacking since they have brought their affliction
upon themselves. Or, to take an example closer to home, though shaving
of the beard is the fashion, so much so that the bewhiskered male is
subject to ridicule, the adult male must show that he has a beard though
it be shaven; that is, his countenance must not be as smooth and fair as
a woman's. Should it be, he is disparaged for ambiguous sex identification.
It is this meaning that is necessary for the understanding of the emotional
rejection of a truly beardless face, and is probably more immediately
responsible for such rejection than economic conditions. Of course, one
can propose that the reaction to possible sex ambiguity is in itself a
product of the economic structure. Economic factors may indeed play a
role, but the diverse meanings associated with physical attributes that exist
in the present, whatever their historical origins, must still be identified.
Where the discussion of attitudes and their determinants suggested
implications for child rearing and public education, these were made
explicit. Undoubtedly, further consideration of implications will yield
additional leads for developing wholesome attitudes toward disability.
Understanding underlying conditions within a framework of ideological
and ethical prescriptions provide the soundest guides for desired change.
An essential problem remains, however: an understanding of the process
of change itself. Though by no means the whole story, some notions on
this matter have already been presented in the discussion of value changes
in acceptance of disability. Chapter 5.
The following four chapters deal mainly with rehabilitation procedures
as such. The first of these presents a variety of training approaches that
are promising in helping the person with a disability to manage more
comfortably and effectively the everyday interpersonal relations described
at length in Chapter 9.
11
Chapter
Training in Social Skills
It bears repeating that a person's reaction to social incidents is
conditioned by how he perceives himself and his disability — i.e., by his
self -concept (see Chap. 7). Nevertheless, the form his reaction takes may
in itself go a long way in worsening the disturbing relationship, or in
controlling it, or even in shifting it to a congenial interchange. More
than that, it may have some consequence for his own self-regard, for
both behavior and the self-concept are reciprocally interdependent — they
are both cause and effect of each other.
The individual himself experiments with different coping techniques,
and on the basis of "trial and check" (an expression credited to Robert
S. Woodworth) adopts those that seem appropriate to him. However,
there is reason to believe that special training in social techniques can
prevent painful ineptitudes and lead to a deeper realization of construc-
tive social relationships.
ROLE PLAYING
Role playing is a method in which problem situations are acted out by
various members of the training group who have been assigned to certain
roles. It stems from psychodramatic methods of therapy used by Moreno
(1937). The method will be described here, but it must be used judi-
ciously and by persons who have the background of training and outlook
to channel the experience constructively, for role playing, like any profes-
sional tool, can be harmfully misused.
The form of the role playing can vary widely, depending on the
purposes of the session. "The problem situation and the roles to be played
may be defined so strictly as to constitute ... a demonstration; or they
may be set so loosely that the 'play' is highly spontaneous and the out-
come all but unpredictable. The play may deal with a single incident, or
it may contain a series of incidents each growing out of the preceding one.
Various individuals playing parts may be instructed as to how to react if
certain events take place, or they may be told to react 'naturally' "
(Bavelas, 1947:184).
21 A
Training in Social Skills 275
To teach social skills, it is Bavelas' experienced judgment that effective
role playing requires ( 1 ) the use of carefully planned "stereotype" situa-
tions as basic training material, and (2) rather close controls of all roles
being played, with the exception of the role primarily under considera-
tion— that one being left entirely free to be played as the individual sees
fit (Bavelas, 7 947; 187).
The following is an adaptation to disability problems of an outline by
Bavelas describing the succession of events in a typical role playing
session (Bavelas, 7947.187-189). Let us imagine a group of ten persons
with orthopedic disabilities gathered together:
1. The session is begun with a short discussion of the general area in
which lie the problems to be taken up. In our example, it is the ordinary
social experiences encountered daily by a person with a disability. The
group may be encouraged to tell about cases or personal experiences that
illustrate the various aspects of the problem.
2. If this is the first time role playing has been attempted, a few minutes
should be spent explaining what role playing is all about. It might be
pointed out that often a person thinks he knows how he should behave,
but when he attempts it in actuality it doesn't work out; that research has
shown that living the situation by acting it out allows for direct observation
of the pitfalls and positive consequences of different behaviors and for
discussion on the basis of a common and real experience.
3. Two of the participants are then selected to go out of the room.
Particularly if role playing is new to the group, individuals should be
selected who are expected to have least trouble in entering into the spirit
of the thing.
4. The problem situation to be enacted is then described. This might be
developed from an earlier discussion on problems of everyday relation-
ships, but often the situation has greater teaching value if it has been
carefully planned by the leader in advance of the meeting. It might be a
situation in which a person with an obvious disability realizes that two
strangers are staring at him and talking about him. Enough background
material should be given so that not only will the problem come alive but
also the persons who are to play the auxiliary roles (in this case the two
strangers), should have a fairly clear notion of how they are to feel and
act. For example, the details might be:
(a) The two strangers, a husband and wife who are seated in a bus,
watch a man with crutches and leg braces laboriously enter and find a
seat, (b) The husband and wife have a son who a few years ago suffered
severe crippling in an accident, (c) They watch the man intently because
they are very much interested in his Canadian type crutches (short
crutches which are held by the hands) . Their own son uses the long arm
276 Physical Disability — A Psychological Approach
crutches, (d) They comment about this together in a low tone. They
wonder if their son could be fitted with short crutches, (e) They smile
in a friendly way at the man when he glances in their direction.
5. Two members of the group are selected or volunteer to play the
roles of husband and wife. In initial sessions, the trainer himself may
play one of these roles. If the group is very small, one person may play
the husband or wife with an imaginary partner.
6. It is pointed out that the individuals out of the room who will play
the man with the crutches and braces (the primary player) will not be
told anything about the strangers. The primary player will simply be
informed that the scene is a bus which he is to enter with some effort and
find a seat. He notices two people staring at him and talking about him,
7. Enough simple "props" are set up to bring the situation to life. In
this case, chairs may be used to indicate the seats of the bus. Their
arrangement is important for it should allow for varied behavior on the
part of the main actor in interacting with the strangers and choice of a
seat. The accompanying illustration presents one possibility. The strangers
occupy two adjacent front chairs.
Front of bus
Rear
8. The group is asked if the setting is clear. It is well for some discus-
sion to take place which will orient the group as to what they are to look
for. Questions may be raised briefly, such as "What might the man on
crutches do? Will he feel self-conscious? Will he feel angry? Hurt?
Annoyed? Undisturbed? How will these feelings manifest themselves?
Why did he choose the seat he did? What was he thinking?"
9. One of the persons waiting outside is then called in. The setting is
Training in Social Skills 277
explained to him, and the action may be started: "The problem is clear?
Very well. You are entering the bus here. It takes quite a little effort. You
notice these two people watching you. You are to find a seat and behave
as many people would in such a situation." Because the primary player
is asked to act the role of someone in general with his disability rather
than of himself, he is protected from the threat of too great personal
exposure. In later sessions, when the group has reached the security of
competent guidance, personal roles labeled as such may more safely be
enacted. Discussion of the behavior in either case is productive of real
insights.
10. This kind of situation may end by itself with the man finding his
seat and, for example, gazing out the window. Sometimes the situation
does not come to an end naturally if left alone. The trainer must then
decide when the play has gone on long enough for the purposes he has in
mind and arbitrarily end it.
11. The primary player is then asked to take his place with the group.
Those parts of the problem of which he is not aware are explained to him,
such as the fact that the strangers had a son with a disability, so that he
can watch the second player on a par with the rest of the group. The
trainer briefly sums up the action that took place in the first play without
giving any interpretations. Sometimes it is helpful to outline the events
briefly on a blackboard and cover it up before the second play starts.
Discussion does not take place at this point. Rather the group is primed
to look for differences between what they have seen and the next play.
12. The second player is caUed in and the procedure is repeated. The
persons taking the role of husband and wife essentially repeat their
previous behavior.
13. When the second play has ended, the leader sums up the action of
the play and reviews what happened in the first one. The review is
important because the second player must be brought up to date. If a
blackboard is used, there will now be two outlines, each describing the
action in one of the plays.
14. Before general discussion begins, it is usually best to ask all the
actors for their reactions. This gives the players a chance to point out the
errors that they have made and serves to give the group additional in-
formation.
15. The meeting is then opened to general discussion. It is sometimes
helpful to get a third outline on the board indicating what the group now
feels would be the preferred behavior of the man with the disability. The
preferred behavior should be examined in terms of principles since there
is generally no one best way of doing things.
16. A member of the group who has not yet played a role is selected to
act out the main role along the lines indicated by the group. The group
278 Physical Disability — A Psychological Approach
is instructed to watch carefully for flaws in what they have set up as
"preferred" behavior.
17. There is considerable value in making a tape recording of the role
playing. This permits checking remembered events against the actuality
and listening again to the nuances of verbal expression and tone.
Modifications of this type of role playing session to fit specific condi-
tions and purposes readily suggest themselves. A white cane and dark
glasses can be substituted for the crutches and braces. The group can
consist of persons with diverse disabilities or similar disabilities and even,
in special instances, of persons with disabilities and those without. The
sex and age of the characters can vary. Problem situations involving help,
sympathy, pity, ridicule, curiosity, nonparticipation can be tried. The
primary character need not always be a person with a disability; it may
be enlightening to the person and the group to center on the role of an
able-bodied person.
Bavelas (1947) points up the following advantages of role playing,
which are here illustrated in terms of disability problems (pp. 184—85) :
1. Playing a role before an "audience" makes an individual self-
conscious. This self-consciousness is desirable because it makes the indi-
vidual aware of his actions in a new way. Commonly the person makes
the same mistakes he has been observed to make unconsciously in real
settings, but because he has become "sensitized" to himself, he is able to
point out some of these errors himself as soon as the play is over.
2. Since the secondary roles are also played by members of the group,
it is possible to get direct expression of the effects caused by the actions
of the primary actor. For example, the persons playing the role of the
curious strangers can report how it made them feel when the man on
crutches acted the way he did. This helps the trainees to get a better
insight into the effects of their actions on others.
3. Sometimes the individual who has just played the role of the person
with a disability assumes the role of the able-bodied in the very next play.
This offers the stimulating experience of "feeling the difference" between
the two positions.
4. The fact that sooner or later everyone takes a turn at playing a role
alerts the audience to the positive and negative features of the current
play.
5. Role playing has the advantage of emphasizing showing how one
would do something rather than telling how one would do it. Many indi-
viduals who "talk a good game" are woefully inadequate when it comes
to performing the actions.
6. Role playing is conducive to experimentation in ways of behaving.
The mistakes made do not have negative consequences for real-life situa-
Training in Social Skills 279
tions. Moreover, the atmosphere in role playing sessions is (or ideally
should be) warm and sympathetic rather than blaming.
Role playing can be used in any setting in which a group of persons
with disabilities can be brought together — the hospital, rehabilitation
center, or school, for example. The importance of a good leader cannot
be overestimated. He must be a person who understands disability prob-
lems, is sensitive to the feelings of the group, and if possible has had
training in role playing as well.
Several experiments have demonstrated the positive changes that can
be initiated in role playing sessions. As part of the series of experiments
already referred to (pp. 219-221) on answering antiminority remarks,
subjects were given training with respect to the manner and content of the
most effective answers (Citron and Harding, 1950). The basic training
method was role playing and discussion. In the role playing sessions, the
subjects assumed the role of the answerer to the bigot's remark. Discussion
of the incident followed. Five sessions of about two hours each produced
marked improvement in ability to answer according to principles based on
general psychological knowledge, on experience with incident situations,
and on the results of previous experiments. Role playing and discussion
have also been used as effective methods in the training of leaders
(Bavelas, 1942; French, 1944; Lippitt, 1943; Zander, 1947), management
(Bavelas, 1947), foremen (French, 1945), interviewers (Barron, 1947),
etc.
It is Lippitt's conviction that "a training process which aims to effect
changes in the behavior style of a person cannot efficiently depend upon
lectures or other patterns of verbalization such as discussion. Actual
experimentation in the desired 'ways of behaving' must be provided,
in situations where intensive guidance and encouragement is possible, and
where the pressures against making mistakes are removed" (Lippitt, 1943:
291-293). Role playing is a widely accepted approach for effecting
change both in behavior and attitudes.
REAL-LIFE SITUATIONS WITH A PERSON WHO "KNOWS"
A second promising teaching procedure is to deal directly with real-life
experiences by having the person who is faced with a disability accompany
someone well adjusted to his disability on various social excursions.
Russell (1949), the veteran who lost both hands in World War II, was
fortunate enough to have such an experience while still in the hospital.
Charley McGonegal, whose hand amputations antedated Russell's by one
World War, took a drive with Russell and Tony, a hospital mate:
280 Physical Disability — A Psychological Approach
... At first we thought he was joking. How could anyone with hooks, even
if he was Charley McGonegal, handle a car? We soon found out. Charley
didn't have any special gadgets or gimmicks on the steering wheel or gear-shift,
but he was a smooth, capable driver. After we'd driven awhile, he stopped the
car and let Tony and me try it. To my surprise, I discovered it wasn't very
difficult at all. I just grabbed hold of the wheel with my hooks and off we went.
But the incident that left an even deeper impression on me took place that
afternoon. Charley drove us into town and we stopped off for a soda. He
steered us to the most conspicuous table in the place and ordered sodas and a
package of cigarets. When the waitress brought the cigarets he made quite a
show of opening the package, pulUng out the cigarets, passing them around and
hghting them for us. Everyone in the store watched him as if it were some kind
of theatrical performance which, as it turned out, it was. Charley wasn't the
least bit disconcerted by their fascinated stares. He acted as cool, as uncon-
cerned as though we were all alone.
On the way back to Reed I noticed something odd. He pulled out a silver
case filled with cigarets, lit one. Then I got the point of that little performance
back in the soda parlor. He purposely ordered the pack of cigarets, which he
didn't really need, just to show us, in his own quiet, indirect way, how to
behave with strangers gawking at you [pp. 108-109].i
The effectiveness of such an experience can be partly attributed to the
following dynamics. McGonegal gave meaning to the situation by his
behavior. Instead of indicating that the situation was threatening, by his
nonchalance he produced a totally different interpretation. Strangers
gawking could gawk without ruffling the object of their curiosity. In the
same way does parental teaching often proceed. The child may not be
afraid to be left in the nursery school until the oversolicitous behavior
and concerned look of the parent tells him that this is and should be a
dangerous situation. Situations often become fearful, embarrassing,
friendly, or comfortable, depending on the meaning defined by the
behavior and reaction of others.
It should not be assumed that one such experience as Russell had, how-
ever impressive it was, is enough to ensure smooth social relationships in
the future. Russell had yet to suffer much bitterness in his encounters with
others, for until he began to accept his disability, the experience with
McGonegal could be only potentially helpful. But it was there, as part of
his reservoir of meaningful recollections, to aid him when he was ready
to utilize it.
Again, modifications of this procedure may be introduced. The size of
the group venturing forth can be varied, as well as the situations to be
experienced. Discussion of the experience may follow, or its impact may
1 Harold Russell with Victor Rosen, Victory in My Hands, copyright 1949.
Used by permission of the publishers, Farrar, Straus and Cudahy, Inc.
Training in Social Skills 281
well be left to be digested alone. A second expedition to the same setting
may take place so that the person can observe change in his own reac-
tions. He may be encouraged to take a lead in the ongoing social events,
or he may be allowed to assume a back-seat position from which he can
still observe and experience. In any case, observing the behavior of an
experienced person in a situation which is of great moment to the subject
is apt to leave him with an impression so potent as to produce changes
in feelings and behavior.
It would be well for administrators of rehabilitation programs to reflect
upon this matter. Just as provision is made for the employment of physical
therapists, so ought provision be made for the employment of persons
with disabilities whose adjustment and experience have taught them
wisely. Opportunity could then be provided for patients to be exposed to
a variety of real-life situations with a person who "knows."
REAL-LIFE SITUATIONS WITH OTHER NOVICES
Real-life situations are also experienced to advantage by groups of
persons with similar disabilities, all of whom are "learners." The fact
that there is likely to be a variety of reactions and interpretations of the
situation tends to stimulate reappraisal of the disability and events con-
nected with it. In an early experience, during his first pass to town from
the hospital, Russell (1949) became bitterly upset when a stranger offered
drinks and made reference to his hands (see pp. 162-163). He defiantly
ended the episode by ordering the man away and shaking his hooks at
him, threatening, "Before I give you these." The following conversation
then took place among the buddies:
"I guess maybe we better get used to have people pester us like that," one of
the boys said.
"Why the hell should we?" I said. "It's none of their damn business. Would
any of us go up to somebody and ask him if he was wearing a toupee or had
store teeth?"
"Maybe they just figure we're heroes and belong to them, our great, adoring
public — "
"Nuts!"
"Or maybe they think it's patriotic to be interested in us — "
"Or maybe," one of the others said, "they feel kind of guilty because they're
not in there pitching and so they want to make up for it by slobberin' all over
us" [p. 123].
Russell learned much as a result of this experience, even though he
could put it into practice only gradually. He learned that people like him-
282 Physical Disability — A Psychological Approach
self, other amputees, could see some acceptable motives in the stranger.
His buddies implied another way of handling the situation predicated on
the proposition that they ought to get used to the behavior of strangers.
Such suggestions are more apt to be taken seriously by the person when
they come from someone who also has a disability, for otherwise it is
natural to discredit the advice with the indictment that a nondisabled
person "just couldn't understand."
Rehabilitation and hospital centers might well consider the feasibility
of arranging excursions into the outside world by small groups of patients.
There the patients will be exposed to the staring and curiosity of strangers,
the offers to help and expressions of sympathy and devaluating pity, but
they will experience these situations together, and together they will be
able to discuss them. In so doing they may discover new meanings and
more effective ways of managing. Variations, of course, may be intro-
duced. An experienced person, for example, with or without a disability,
may be called in to join the discussion. Eventually the patient may be
encouraged to venture forth alone. For this short period he is on his own,
but when he returns to the temporary refuge of the hospital or rehabilita-
tion center, he will then be able to unburden himself of the questions and
irritations to others who understand.
BRINGING THE OUTSIDE INSIDE
There are other simple and inexpensive methods by which the patient
can gradually be introduced to the uncertain outside within the more
protective environment of the hospital. For example, after the initial
medical phases of treatment, it may be feasible to transfer the patient to
a mixed convalescent ward instead of keeping him on a ward for
amputees, or cardiacs, or for persons with visual ailments. In this way he
comes into contact with persons different from himself. They will stare
and ask questions and offer advice, but they are sick too; he will be
exposed to "ordinary social relations" in an atmosphere in which status
differences are leveled and sympathetic understanding is more easily
sensed.
It may also be possible to provide temporary jobs in the hospital where
the patient can come into daily contact with persons from the outside but
feels that he is not the only deviate. Thinking along these lines opens up
other possibilities. In England, for example, hostels for paraplegics have
been established near light industries. The patients take regular jobs at
the factories while living under medical supervision (Rusk and Taylor,
1946:110). In this country there is a growing development of "member
employee programs" in hospitals. Although remuneration and physical
Training in Social Skills 283
conditioning are certainly among the major purposes of these programs,
not to be ignored is the advantage of being placed in real-life situations
early in one's adjustment to disability imder living arrangements that are
somewhat protected. This kind of step-wise preparation is not, of course,
necessary in all cases of disability.
SHARING LIFE EXPERIENCES THROUGH GROUP DISCUSSION
Free discussion of common problems in facing other people can lead to
ideas never before entertained, ideas which may effect basic changes
within the value system of the person and in his behavior. The following
is a transcript of a discussion by a group of children with cerebral palsy,
ages 11 to 14 years, about their experiences in being with other people.
The discussion is led by their friend and teacher (Sutter, 1954). Joe's
speech is hardly intelligible, Eddy's is moderately involved, and Bobby's,
Carol's, and Lily's is very clear:
Eddy: Sometimes wise guys just come along and decide to pick on you. I
mean sometimes I sat just there and watched these kids the way they talk
about you and the way they look at you and stare at you. I don't know. I
just come to the conclusion that they just have to get used to you.
Teacher: Good enough, Eddy.
Bobby: Well, they kid you about your condition and some of the younger
kids kid you and some of the older kids they kid you saying, "Oh, you can't
run as fast, Oh, you keep falling down. Why can't you run fast and why can't
you talk so good?"
Teacher: Any of the rest of you have any experiences? Like Bobby's? Carol?
Carol: Well, Mrs. Sutter, you know I went to Juilliard School of Music two
summers ago in New York and I spent six weeks in the city and once or
twice when my companion went shopping or when we were even coming out
of our apartment children, I mean, children, would stop me on the street and
say, "Hey, what's the matter with you" . . . because children stop me more
so than adults actually and just saying "What's the matter? What's wrong
with you?" And I'd say, "I have cerebral palsy." And I'd say, "I wouldn't
care," and my companion would try to pull me away from it but I would
just be willing to tell them."
Teacher: It's a good thing to face these things if we have to. Yes, Joe. Joe
is very anxious to say something. AJl right, Joe.
Joe: When you walk down the street people look at you.
Teacher: [Repeating in order to make his remarks understandable.] People
look at you.
Joe: And stare.
Teacher: And stare. How do you feel when that happens, Joe? All right,
tell us.
284 Physical Disability — A Psychological Approach
Joe: [Unintelligibly]
Teacher: The best thing is to ignore them, said Joe.
One of the
Children: Yes, that's what I said.
Teacher: Yes, it is, but how about what you're going to do about the way
you're feeling inside? Yes, Bobby, what?
Bobby: After I tell 'em I say well, take one of the kids who is about five, you
know. And he said, "What's the matter with you? Can't you walk?" I said,
"I've got cerebral palsy." He said, "What's that? Is it like polio?" and I said,
"Something Uke that. If you have it, you have it and you go on."
[1 minute of discussion omitted.]
Teacher: Eddy has wanted to say something over here. Now have you for-
gotten? I hope not, Eddy. You had your hand up.
Eddy: Well, I'm trying to say that many times I walk down the street and
people who are a good twenty or thirty years old and they just stand there
and look at you most of the time. It bums me up, the way they look at you.
It doesn't even bother you if a small child looks at you but you get these
grownup people. I don't know; most of the time I don't say nothing to 'em.
Teacher: No you can't.
Eddy [continuing]: The idea is mostly ignore them but sometimes you can't.
You know. As how you have to tell them something.
Teacher: Yes, Bobby?
Bobby: It isn't the way the grownups look at you, but I remember one time I
was at the theater you know. I couldn't hold still you know. I tried to keep
stiff because people were watching you know. But I just couldn't and one of
them says, "Hey kid, don't you mind your manners or something."
Teacher: Oh, yes. There could be that kind of misunderstanding.
Bobby [Continuing]: But I couldn't keep them stiff any longer because it had
been a long time.
Teacher: Sometimes adult C.P.'s who are out in public and maybe they walk
with sort of a staggering gait with which we are all sort of familiar with,
aren't we?
Children: Yes, we know.
Teacher: And other people, what do they think? [The children say some-
thing]. Yes, they think they are intoxicated. There is that sort of misunder-
standing, too.
f OE [With very belabored speech] : I think sympathy people. . . .
Teacher [Helping him out]: Oh, I'm glad you mentioned that. Sympathy
people, people who are too full of sympathy.
One of the
Children: Oh you poor boy! That sort of people.
Teacher: Tell me about it.
Bobby: One time I met an old lady and I was sorta, I couldn't walk so good
and she says, "Oh you poor little boy!" [Children laugh with amusement.]
Teacher: And what's the answer to that? I don't know. I don't know. Do
you?
Bobby [Continuing]: She said, "You poor little boy. What's the matter with
Training In Social Skills 285
you, you driak too much soda or something?" [Children laugh.] That kind
of stuff makes me sick!
Teacher: Eddy?
Eddy: Well, last night I was in the movies and along comes someone in the
town, a noseybody I should say, and he says, "Oh, leave Mm alone, he's
a — " [Eddy then interjects] you know, I don't like to use this word "cripple,"
and well I just get up and I tell 'em that right off, I tell 'em, "What's it to
you?" I mean, I don't know I just like to tell them so they don't bother me
no more 'cause I just hate that word.
Bobby: And I just hate that word. Because there's a kid up my block who's
always. . . . One time I was walking down the street and this kid was with
me, you know, and an old lady comes along and she almost tripped over me
and she says, "Oh, he's crippled, don't touch him." [said with scorn].
Teacher: There's that word again Eddy said he didn't Hke to use. Let's face
that word very squarely. It's a label, isn't it, that word "crippled," it's a label
and you don't like it, do you?
Children: No.
Teacher: No. Are there any other ways of being crippled than in your legs
or in your hands?
Children [Answering in unison]: Yes!
Teacher: Yes. And in an even more important way, you know?
Joe: Inside.
Teacher: Joe said inside and he meant?
Carol: To be crippled in your feelings!
Eddy: About that, uh, I don't want to go back to that word, . . . about that
idea of people sympathizing with you, and stuff like that. Well, there are two
kinds and don't forget. There are the guys who don't look at your handicap
who look at . . . uh, well, I can give you an example. A number of times
when Allen a couple of years ago here would pick on me and someone
would come up and say, "Lay off. He's smaller than you," or "He can't fight
back as good as you" or ... I mean they don't mention that, they don't
make you understand that you are, as I said before, crippled or handicapped.
Teacher: Yes. That is in other words, excuse me, Eddy, there may be occa-
sions when you really do need help from somebody else but there are ways
and ways of giving help. And now the other kind?
Eddy: The other kind I don't care much for.
Teacher: I know you don't.
Eddy: I just don't hke it, that's all.
Teacher: Yes. Because one has real understanding and the other has none.
Bobby [Excitedly]: Oh, boy! This was an experience. This was yesterday, as
a matter of fact. This guy, he was walking along, you know, and he thought
that I kept falling down when I was walking down the street. And he said
to me, he said, "How do you feel?" and I said, "I feel fine." And he said,
"What's the matter?" I said, "Well, I'm handicapped, that's all." [The rest of
the children laugh.] He said, "Oh, you better see a doctor." Oh boy, that kills
me.
Teacher: Well, this is good for us to talk about. Yes, Lily.
286 Physical Disability — A Psychological Approach
Lily: I also find it very hard to accept the fact when people sometimes see
that you can walk, let's say, all right with one cane, that you're capable.
Maybe they don't see it but when you feel that you can walk perfectly well,
but maybe another person doesn't see it, and they try and help you. You
know they try very hard.
Teacher: That is pretty natural. It's awfully hard not to, Lily. You know,
after aU these years I still have to catch myself. I want to help you. I have
to remember not to. Diane, how do you feel about this?^
What did the children gain from this discussion? How did it affect their
reactions to the difficulties of ordinary living? We do not know. And what
we can guess at is based partly on clinical observations that talking can
bring about change in outlook and partly on faith. How could it be other-
wise than helpful to hear one among the group say, when affronted, "I've
got cerebral palsy. ... If you have it, you have it and you go on"?
How could it be otherwise than helpful to have the children distinguish
between two kinds of "sympathy," the understanding kind and the pitying
kind? The fact that the children could hear each other complain about
some of the annoyances on the outside, the fact that they could laugb
about some of the misunderstandings, undoubtedly serves to relieve somfe
of the burden. When this is bolstered by new understandings of one's own
feelings and the feelings of others, important preparation for subsequent
changes in the management of social relations has taken place.
We do know, however, that discussion is likely to be more effective in
producing change when combined with actually trying out new ways of
behaving than when it stands alone. French (1944) reports a study of
retraining an autocratic leader. In spite of the fact that full discussion
had taken place in the group concerning the advantages of democratic
procedures in leading a discussion, one of the trainees completely re-
gressed to his usual autocratic style when he was asked to lead. The
children with cerebral palsy could well capitalize on their discussion by
some form of reality practice where the new learnings are brought to life
and thus more firmly set by behavioral experience.
DISCUSSION OF A STORY
Stories to prepare a person for experiences that might be painful have
proved useful. It has been reported (Dinkel, 1947) that a Negro father
had considerable success in softening the shock of race prejudice upon
his children through the use of stories that he began telling before they
had had encounters with white hostility. The fictitious Negro children who
" From a tape recording.
Training in Social Skills 287
were the principal characters in these stories went through a series of
incidents of the kind that the father anticipated that his children would
experience. By means of doll play he also rehearsed with his children
techniques that could be used to avoid or lessen the social difficulties that
might befall them. When they later encountered racial antagonism, they
were not disturbed greatly and were able to adjust to it more skillfully
than neighboring children who had not had such careful training.
Stories are also helpful in the case of adults who find difficulty in
referring to their own personal experiences and feelings. By discussing
the behavior and attitudes of a character in a story, direct exposure of
oneself is avoided. Favorable use of stories with adult amputees has been
reported (Dembo, Leviton, Wright, 1956). Insofar as the intention is to
promote behavioral skills as well as adjustive attitudes, it is worth-while to
use some form of reality practice in addition to the verbal exchange.
Note that the Negro father also had his children act out in play with dolls
the techniques demonstrated in the stories. This is a form of role playing.
Each of the training procedures we have considered stimulates serious
consideration of new possibilities of behaving. This is a first step in the
development of more appropriate social skills. When, in addition, these
possibilities can be tried out in reality practice, the opportunity is provided
for testing the new learnings and improving the skill with which they are
executed. The behavior, it must be emphasized, is not alone altered.
Underlying attitudes and meanings concomitantly are affected, and it is
such changes that make possible the well-managed social interaction;
otherwise fhft 'skill" would be only an awkward imitation of the training
model.
12
Chapter
The Parent as a Key Participant
The psychoanalytic movement, as is well known, did much to
emphasize the importance of the early childhood years for personaUty
development. As a corollary to this emphasis, it is recognized that parents
or their surrogates are the pivotal figures who determine in large measure
the eventual psychological fate of their children.
Research is being accumulated to show that, although love is not
enough, genuine love, warmth, and acceptance by the parent for his child
will carry the child far toward developing a healthy personality. "Love, to
be worthy of the name in any human relationship, consists of a sincere
desire for the other individual's best good rather than mere self-indulgence
of the one who gives the affection" (Laycock and Stevenson, 1950:120).
Sommers' study (1944) on adolescent blind children, for example, brought
out that "the lack of satisfying parental love . . . produced a feeling of
loss which seemed to be more injurious to the personality of the blind
child than his lack of sight" (p. 103). The important review by Orlansky
(1949) on such child-rearing practices as breast versus bottle feeding, age
of weaning and toilet training, showed that these factors as such had little
psychological significance for the child's development whereas the attitude
of the parent in carrying out the procedures was crucial. Langdon and
Stout (1951), looking into the lives of more than 250 well-adjusted
children, point out that the background information about the parents
(such as their age, religion, etc.) gives little help in accounting for the
good adjustment of their children. What does stand out from the many
diagnostically insignificent variations is the parents' statement of the "most
important of all" — namely, conveying to the children in behavior and
words that they are loved, respected, and wanted.
Because of the influence of parents on their children, because the
realization of the best that is known concerning the health, education,
and welfare of children with disabilities requires cooperation between
parents and rehabilitation workers, rehabilitation agencies working on
behalf of children must perforce work through and with the parents of
these children.
288
The Parent as a Key Participant 289
QUALITATIVE ASPECTS OF A SOUND RELATIONSHIP
The terms "rehabilitation worker" and "counselor" are used in the
generic sense of anyone working in an official capacity on behalf of a
person needing help — e.g., the doctor, physical therapist, school teacher,
etc. The following are guideposts in building toward a good relationship
with the parent:
1. The parent must feel that the rehabilitation worker is not working
against him, that together they are seeking solutions to problems.
2. The parent must feel that the rehabilitation worker likes his child, sees
him as an individual, a personality.
3. The parent must feel that the rehabilitation worker appreciates his
strengths, his struggle to do the best he can for his child, that though
the parent may have shortcomings, neither are they "picked on" nor
do they lead to rejection of him.
Further analysis of these points, so obvious that they may appear as
truisms, reveals the complexity of feelings with which they are invested
on both sides of the relationship.
Interfering Parental Attitudes
Of great significance is the likelihood that the parent carries to the
relationship certain attitudes which, unless modified, act against the most
productive use of the time together. Considering the rehabilitation worker
as a person in authority, the parent may look upon him with fear on the
one hand and with awe on the other, emotions reminiscent of his childish
reactions to his own parents and to such other authority figures as his
teachers and doctors.
In addition to these diffuse feelings that alert his defenses, the parent
often enters the relationship with a number of well-defined fears. He may
expect, for example, to be blamed for any and all of the difficulties that
beset his child and fear that his guilt as a parent will be exposed. He
may be worried that demands that he is unable to meet will be made on
his financial resources, on his time, strength, and emotional involvement.
He may fear that the expert will shatter his strands of hope that his child
can be cured or at least appreciably helped. He may believe that the
specialist will not understand him as a parent and will become impatient
with his desperate wish that all will be well. He may also fear that the
worst aspects of the reality will be kept from him. Finally, he may be
anxious lest the child become "too attached" to the therapist, this being no
small threat to a parent already uncertain of his relations to his chUd.
290 Physical Disability — A Psychological Approach
Whatever the complex of fears, we can be sure that the parent enters the
situation full of apprehension, hopes, and doubts that often set him apart
from the rehabilitation worker, aligning them at opposite poles until
constructive forces enter with sufficient strength to bring the two together
in a real cooperative endeavor.
Of the constructive forces, those moving in the direction of points 2
and 3 above carry considerable weight. In short, the parent must come to
feel that the rehabilitation worker likes and respects him and likes and
respects his child. That this is not always simple will be seen below.
Interfering Counselor Attitudes
The following are some attitudes which, if carried to the relationship by
the rehabilitation worker, militate against a constructive relationship with
the parent:
"The trouble with children is their parents." This attitude in profes-
sional circles is more common and more resistant to change than we like
to think, for it rests upon many supporting experiences of an emotional
as well as rational nature. To begin with, there is the resentment against
one's own parents which the rehabilitation worker, like other adults, may
feel. The rehabilitation worker has added proof in his own practice of the
lack of wisdom of some, if not many, parents when they fail to carry
through the recommended plan or openly defy it. Moreover, he has the
edict of the theorists who have laid on the parental doorstep the tremen-
dous responsibility for maladjustments in children.
The rehabilitation worker himself, therefore, has to examine and re-
examine his own feelings in regard to parents as a group. Stereotypes
about parents must give way to the reality of the individual parent. The
counselor has to reach the point where, though recognizing parental short-
comings, he can still respect the positives which are there if one looks for
them. Of course the rehabilitation worker cannot ignore the destructive
influences. He must take them into account in planning with the parent,
in working through troublesome issues. He must appreciate that the short-
comings of the parent have their own origins, and the effort to understand
and cope with them must supplant derision of them.
Whether the rehabilitation worker will be positively or negatively
inclined toward the parent largely depends upon the parental character-
istics extracted as the main lines of striving. For example, if the rehabilita-
tion worker sees a particular parent primarily as rejecting his child, even
hating him and wanting to absolve himself of all responsibility, then, to
say the least, a real liking and respect for the parent is precluded. If,
however, the rehabilitation worker sees that parent as torn by conflict, as
being bothered by guilt, as running away from his responsibilities because
The Parent as a Key Participant 291
he is already overburdened with stresses of various sorts, then the
emphasis is on the parent's struggle to come to terms with his problems.
Such an emphasis, being directed toward the growth potential of the
parent in the wake of emmeshing, undermining factors, is one of the best
guarantees that the counselor will look with an attitude of acceptance
essential in constructive counselor-client relationships.
This point is another example of the principle of positive identification
referred to on page 148. There it was pointed out that, by highlighting
and identifying with the aspects of coping with disability, the person
himself is able to relegate devaluating aspects of his physique to positions
of little influence on the self-concept. Similarly, the rehabilitation worker
can truly respect the positive strivings of the parent, for even the most
disreputable person is not lacking them, and he can look upon the destruc-
tive forces as unfortunate interferences which, in some cases, may require
therapeutic handling and in others managing in spite of them.
The professional person must orient himself to parents by the principle
that generalizations about parents (and about any group for that matter)
have to be made with caution, that he is far better prepared to see the
parent as he is if he remembers that "parents love and hate . , . [handi-
capped] children just as parents love and hate children who are not
physically impaired. Parents protect, guide wisely, pamper, neglect, and
even abandon children whether or not they are handicapped. Some chil-
dren were unwanted, but are loved and have the security of a healthy
relationship with their parents. Some children were wanted, but are un-
loved and insecure, whether or not they are sound of mind and body"
(White, 7955;470).i
"My job is to provide the answers." The key to the psychological issue
involved in this deleterious attitude is revealed with the metamorphosis
produced by the grammatical substitution of "our" for "my." The parent
as a member of the rehabilitation team has answers too. His set of answers
is no less important than that of the professionally trained person, and the
best solutions can result only from a dovetailing of both. The audiologist,
to take a concrete example, knows far more about audiograms and hearing
aids than does the parent, but the parent, after all, knows many things
about himself and his child that are not known by the audiologist. Even if
a social worker, psychiatrist, or psychologist is part of the team, the
knowledge, insights, and lack of insights on the part of the parent are just
as essential and worthy as are the knowledge, insights, and lack of in-
sights on the part of the professional worker.
^ G. White, Social casework in relation to cerebral palsy, in W. M. Cruick-
shank and G. M. Raus (Eds.), Cerebral palsy: its individual and community
problems, Syracuse University Press, 1955. By permission.
292 Physical Disability — A Psychological Approach
Furthermore, since the parent in most cases must assume the ultimate
responsibility for his child, it is necessary that he actively participate in
the rehabilitation process from the beginning. He will be ill prepared for
the many independent judgments he will have to make if, during his
contact with the rehabilitation situation, his primary role was that of
passive listener to the wisdom of the diagnosticians.
It should also be anticipated that the parent's admixture of awe and
fear, of gratitude and resentment, of pride and guilt, of self-respect and
self-pity will tend to keep him in a turmoil and lead him to expect and
accept his role as second-class listener. This means that the rehabilitation
worker must actively encourage questions and opinions on the part of the
parent. It means that the parent needs time to disentangle his feelings
and thoughts and to absorb the new information presented to him. Op-
portunity should be given for more than one contact with the professional
person, because questions and formulatable opinions often come after
the parent leaves the counselor's office. He should be asked to write these
down for the next occasion, an occasion that will still open the dam to
the flood of fears and anxieties.
We even venture to propose that systematic research be done on how
and when the parent can well serve during case conferences as an integral
and equal part of the team planning for the child. To be sure, the parent
sometimes does work through the problems of his child in more or less
equal partnership with a single therapist — the social worker or teacher,
for example. But in the usual team approach, the parent is typically
excluded. Traditionally, the team approach describes case management in
which at best the several therapists (e.g., orthopedist, speech correctionist,
psychologist, pediatrician, social worker, occupational therapist, physical
therapist, etc.) gather together, each reporting his findings and as a group
arriving at conclusions, but without the parent. One of the experts then
conveys certain of this information to the parent. In support of this, it is
assumed that the presence of the parent would interfere with the frank
presentation of facts that would be disturbing to him.
However true this may be, it is well to weigh these considerations
against such negative effects as the following: (1) The parent gets the
feeling that much is being said and done behind his back. (2) Decisions
and conclusions are made, albeit in the form of recommendations, without
his active participation. This always carries the danger that the parent will
be unable or unwilling to carry them out. (3) It places the parent in the
position of a child who has to be told what to do without having a real
say in the telling or doing.
Even though one may want to spare the parent who is just beginning to
face the realities of the struggle ahead, surely in follow-up conferences.
The Parent as a Key Par+icipant 293
for those parents who are adjusting to the realities at hand, the possibility
of full participation on the team should be explored.
The findings of systematic research may surprise us on several counts.
They may show that nothing is lost if things that would unduly hurt the
parent are not said. They may show parents to be abler than we think
to withstand an honest discussion of their child's problems, especially if
matters are discussed realistically and hopefully at the same time and with
full respect for the parent. They may establish clearer criteria as to which
parents are and are not ready for such participation, as to which parents
are emotionally still so involved that a presentation of the problems from
many points of view would be so overwhelming as to interfere with
problem solving. They may make evident that nothing is basically lost if
even the indifferent parent or the parent with borderline mentality is
present at the conference and that something valuable may be gained. It
may show that the time required for explanation of technical terms is time
saved in the end, for the participation of the parent at the conference
makes possible the introduction of further facts and a point of view
essential to a sound consideration of the total problem.
If one seriously respects the parent, if one is confident that he can win
out in his striving to work through the problems that face him and his
child, then the conviction emerges that more often than not the parent,
in the long run, will be an asset as a full and equal member of the reha-
bilitation team. The parent is, after all, generally the only person who has
lived with the child for 24 hours a day over the years of the child's life.
Few professional persons, in fact, can claim such intensive experience
with children as part of their formal training. Does one dare to say that
the parent knows and understands his child less well than an outsider?
Only in some instances, and in regard to certain problems. It is more
correct to consider him an expert, just as the professional worker is an
expert, each bringing to the discussion an important point of view and
special understandings of the child.
Of course, the successful realization of such parent participation also
requires certain mature attitudes on the part of the specialists, particularly
that of liking and respect for the parent and child as well as a readiness
to admit to their cloisters a fifth estate, the parent, who also is an expert
in his own endeavor. Certainly, too, we need to know a good deal more
about types of conferences, including their structure and procedures, so
that that approach can be selected that is most constructive for particular
purposes. This is a problem of group dynamics and requires the aid of
research. Thoughtful, systematic observation of current practice and
research on untried procedures holds promise of making better use of the
parent as a key participant in the rehabilitation process. This issue is also
294 Physical Disability — A Psychological Approach
applicable to participation of the adult client in case conferences and is
raised later in that connection (Chap. 14).
"/ do not feel comfortable with disabled people." This is another
attitude on the part of the specialist that interferes with a productive and
close relationship with the parent. Particularly interfering are such
emotional attitudes toward disability as aversion, devaluating pity, and
dislike. Such feelings countermand one of the cardinal criteria of a con-
structive rehabilitation relationship — namely, that the parent believe that
the counselor likes and respects his child. Confidence in the specialist
cannot easily be developed when his belief in the child as an important
and to-be-loved individual is doubted. Moreover, the opportunity for the
parent's own attitudes toward disability to be positively affected is lost. In
a sound relationship the specialist, by his own wholesome attitudes toward
disability, conveys to the parent that a person is not his disability, that
the child can have a full measure of life's happiness though he will have
his share of its sorrows. Next to eradicating the disability itself, the
parent's supreme wish is that this be true. This attitude of the professional
person can be so comforting that the parent begins to view the disability
not as an overwhelming tragedy but as a reality which can be lived with.
Finally, of course, the child's own responses and behavior will be affected
by the attitudes of the rehabilitation personnel with whom he comes in
contact.
The main antidote to emotionally negative attitudes on the part of the
rehabilitation worker toward persons with disabilities lies in self-under-
standing, in making a real effort to come to grips with what one basically
feels and why. It is hoped that a volume such as this, in exploring some
of the social-psychological factors important in adjustment to disability,
in considering attitudes as fundamentally involving value issues, will pro-
vide some of the directions that such a self-analysis can take.
The proposed self-analysis takes place under favorable conditions when
the specialist is actually working with persons who have physical dis-
abilities, for then emotionally he begins to see people and not simply
diseased and deformed structures. As one teacher reports: "I remember
my first visit to the hospital — my feelings of revulsion at the disfiguring
conditions of the children. Gradually I came to grips with myself and
began to understand some of the reasons for my feelings. By the fourth
clinic session, I was completely at ease. These were children who needed
help. I hardly noticed the disfiguring conditions which had first repelled
me. I know now, that what counts is not the handicap, but what is done
with it and about it. Teaching these children is a challenge and a charge —
but most of all a richly rewarding experience" (Helping the physically
limited child, 1952-1953).
Although the underlying attitudes of liking and respect for the child and
The Parent as a Key Participant 295
the parent are so fundamental that one wants to underscore it as all-
important, there are some rules in the order of techniques for interacting
with the parent that aid in conveying it. The desirability of stressing or
referring to the assets of the child before his liabilities has been mentioned
(Laycock and Stevenson, 7950.133). Even if the counselor knows that
the parent wants to find out just what the situation is with respect to the
disability and would be impatient with any excursions about other charac-
teristics of his child, however laudable, a brief transitional phrase point-
ing to a positive attribute can be an important cue to the parent that the
counselor stands behind his child. What one says — and how one says it,
of course — will depend upon the personality and convictions of the
rehabilitation worker. As illustrations, the following remarks of a psy-
chologist in opening the conference with parents concerning their deaf
children are presented: "Mary was awfully good during the examination.
. . ." "Do you know that David has developed exceptional skill in speech
reading? ..." "Such a smile! Even the children around him sense that
he is friendly." Needless to say, the rule to start with the positive will fail
completely unless the words also silently convey "I like your child. He
matters. Our search together will be rewarding. . . ."
Certainly one doesn't have to wax maudlin. On the contrary, the emo-
tional relationship should be restricted to warm but not demonstrative
acceptance and support for the efforts of the parent and his child. The
parent often is already so deeply involved that he can well do without
additional emotionalism which feeds into self-pity or the tragedy of the
situation. Doubtless, mere reference to disability-connected matters will
cause some parents to spill over, to become overwhelmed with their un-
certain hopes and still more uncertain fears. The counselor then needs to
stand by, sometimes putting into words the feeling that can also be silently
conveyed — namely, "I understand. Things will get better. Both you and
your child will manage."
The following rule is mentioned only because it is so often violated:
The rehabilitation worker should make a conscious decision each time as
to whether the child ought to be in the conference room. Sometimes the
child's presence does not matter or can be helpful. When the physical
therapist is explaining the exercises that will have to be done daily at
home, the child is needed for demonstration. Besides, this is a matter-of-
fact area where, by listening, the child is learning what to expect and what
is expected of him. But, when the therapist is discussing with the parent
the difficulties at home that are upsetting to the child, or when the surgeon
is describing the nature of the operation soon to be performed on the
child, etc., etc., what then? The answer is obvious, but evidently children
are so easily regarded as unknowing entities that even professional people
fail to consider the effects of their presence. It means that the rehabilita*
296 Physical Disability— A Psychological Approach
tion setting has to provide facilities for the care and occupation of the
child while the parent is in conference.
TOPICS AND UNDERSTANDINGS COMPRISING A
BROAD REHABILITATION PROGRAM
In addition to the significance of the underlying emotional relationship
between counselor and parent, there are many specific topics and insights
that should find a place in a total rehabilitation program. The following
summary draws heavily upon a thoughtful account by Laycock and
Stevenson (1950) of parents' problems with exceptional children.
• Parents must be helped to realize that handicaps in children are part
of the general problem of human imperfections, which all must face in
themselves and in all other human beings. The problem of parents of
exceptional children is therefore not unique but applies to all parents.
These are not mere palliative words, for all parents must learn to accept
the limitations of their children.
• Parents make a tremendous step forward when they realize that any
course other than acceptance adds to the child's handicaps and increases
their own difficulties.
• Parents can be helped to see that frequently it is not the handicap
that hinders a child's adjustment, but how he himself feels about his
handicap.
• One of the best helps that can be given parents comes from under-
standing the potentialities of their children. Instead of concentrating on
the fact that the child will never walk, for example, the parent can be
helped to lay emphasis on the fact that the child can be taught to use his
hands and to talk. In this way the coping rather than the succumbing
aspects of the situation guide the emotional and practical life of the person
(see pp. 59-61). The important point is that every parent must adjust
to what his child can do.
• Parents need to understand that their exceptional child is funda-
mentally like all children, that "all children need an adequate and
balanced diet, sufficient rest and sleep, a comfortable temperature, and
activity when well rested, that all need to be loved and wanted, to have a
reasonable independence in running their own lives and in making their
own decisions, to feel a sense of achievement that comes from making
things and doing jobs, to win the approval of others for what they are and
do, and to feel that they are worthwhile individuals who reasonably come
up to their own standards" (Laycock and Stevenson, 1950:123).
• At the same time, the parent needs to recognize the special problems
The Parent as a Key Participant 297
brought about by the disabihty of his child. But such recognition must
be coupled with precautions against the natural tendency to view all or
most of the child's growing-up problems as disability-connected. (See
spread, pp. 118-119.)
• The parent needs to understand the different means that may have to
be used in the education of his child.
• The parent may have to be helped to face early separation from his
child in hospital and school.
• The parent will have questions about medical aspects — cause, course,
and treatment — of the disability. There will be anxious questions about
hereditary implications regarding the matter of further children and grand-
children. Here is a place where the all too common feelings of guilt can
be brought to the surface and, with proper handling, to some extent if not
largely dissipated.
• Parents need to reach some understanding of the relative roles of
maturation and learning in the child's development and to realize that the
child has to be ready for the next step in his progress before he can take it.
• The dangers of comparison with other children need to be realized,
and the child's own progress needs to be accepted as the primary basis
for evaluation.
• Instructions as to how the parent can best help the child at home in
the development of specific skills should be given. But the therapist must
be careful not to make too great a demand on the parent's time and
energy (or on the child's, of course), appreciating that the parent has
many other responsibilities in regard to maintaining the family.
• The parent needs to appreciate that progress in the child may require
a great deal of regular practice and much encouragement as well as imtold
patience on the part of the parents themselves.
• Parents should become aware of the threats to the emotional security
of their children caused by continuous quarreling in the home, major dis-
agreements between the parents in regard to child-rearing practices, in-
consistent or baseless discipline, dominance or coddling of the child, the
playing of favorites by the parents, and the feeling on the part of the
child that he is a burden.
• Parents need to understand important practical principles of child
guidance. The usual areas of concern should be explored, such as toilet
training, sleeping, eating, thumbsucking, nailbiting, bed-wetting, temper
tantrums, etc. Parents also need understanding with respect to sibling
relations, sexual development and sex education, the development of
constructive social patterns of behavior, shyness and aggression, problems
of discipline and, later on, the considerations involved in vocational
choice.
• At the same time it must be recognized that, though rules are helpful.
298 Physical Disability — A Psychological Approach
they are far less so than we might imagine. In no case can they take the
place of love for the child, of sensitivity to the child's reactions to the
learning experiences to which he is exposed. The parent needs to grasp
not only the "letter" of the rules and principles but also their spirit.
• Parents, too, need to be prepared for the ordinary frustrations and
gratifications aroused by their child's disability. Help in meeting the
curiosity, rejecting attitudes, sympathy, and devaluating pity of neighbors
and friends should be part of the rehabilitation effort.
These are some of the areas that should be tapped in a broad rehabilita-
tion program involving the parents of children with disabilities. There are
others. The rehabilitation team can decide which of the topics above
belong to whose domain. Actually, many of them cut across specialties
and in one way or another are related to the work of all. The importance
of the rehabilitation worker as a counselor and as a person cannot be
overestimated. Training and skills are essential but so are wisdom and
maturity.
Fortunately, there is a growing body of excellent reading material to
which parents can be directed for sound information concerning child
development in general and matters revolving around disability in particu-
lar. Spock's classic book on baby and child care can unquestionably be
recommended, and its brief review dealing with the handicapped child
contains basic wisdom of benefit to any parent (1946). Lowenfeld's book
(1956) written especially for parents of blind children is first rate. Mykle-
bust's book (1950) written for parents of deaf children, to say nothing
of the many pamphlets and articles distributed by national and private
organizations concerned with problems of disability, all offer enlightening
and encouraging material which can be a real source of help and comfort
to parents. They provide technical information concerning questions of
etiology, treatment, and home management; they convey basic attitudes of
realistic yet hopeful acceptance. Suitable autobiographical accounts can
also extend the horizons of parents. Of books written by parents, the one
by Henderson (1954) dealing with the blindness of her child and the one
by Bruckner (1954), which reveals so well the passion in first rejecting
and then meeting the challenge imposed by her son's crippling, are ex-
amples. The amount of autobiographical material written by persons with
disabilities is vast, and almost any of it can help a parent toward fulfilling
the insatiable demands of understanding.
The world-famous library of the National Society of Crippled Children
and Adults, in Chicago, 111., will provide the parent (and the professional
worker) with sources of bibliographical material covering many areas of
child development. Other national organizations, such as the Volta Bureau
in Washington, D.C. concerned with problems of deafness, and the
American Foundation for the Blind, Inc., in New York City, also maintain
The Parent as a Key Participant 299
reference and lending libraries. Guidance materials distributed by state
departments of education or social welfare and the Department of Health,
Education, and Welfare of the federal government are also available.
If they are to be used to best advantage in the relations between parent
and child, the knowledge and insights must be emotionally accepted as well
as intellectually understood. In this connection the sustaining power of
certain religious precepts which posit in disability a purposefulness divinely
ordained may be mentioned. Karen's mother, for example, strengthened
by her religious beliefs, conveyed a comforting outlook to her child
crippled with cerebral palsy:
. . . She [Karen] had been singing contentedly and broke off in the middle
of a bar. Looking at me squarely, she asked, "Mom Pom, why did God make
me a cripple?"
"Here it is," I thought, "and I'm not ready after all." I breathed a swift
prayer for guidance. I fully realized how much depended on my answer. I
dried my hands and sat at the table beside her.
"I think, Karen, because God loved you better than most people," I answered
slowly. "He didn't pick Gloria or Marie or Rory [Karen's siblings] to be C.P.;
He picked you. You have suffered already and you will suffer more. Not only
will your body be hurt at times, but your mind and your heart. It takes a very
special person to handle hurt." I moved closer to her. "Karen, whom do you
think God loved more than anyone else in the world?"
She pondered. "His mother, I guess."
"You're right, darling. He loved His mother more than anyone else, and yet
he allowed her to suffer more than anyone else. Suffering, sweetheart, is a sign
of God's special love. TTiat's why you're crippled and we are not. He just loves
you more, that's all."
"It's hard, but I'm really lucky. It's all right now I know" [Killilea,
/952;212].2
And Karen's mother feels that she is privileged to care for Karen:
1 had never thought that "capable" hands (the tactful way of referring to
large hands) would be a source of gratitude. Nor that the years spent on tennis
court and in fencing would produce anything but the problem of covering
bulging biceps, summer or winter. That both would one day be a source of
facility and strength in teaching my child to walk, could never have occurred
to me. God works in mysterious ways. In giving me a passion for sports and
an aptitude thereat. He had been equipping me since childhood for a task not
entrusted to the average parent [pp. 81-82].
Mrs. Bruckner, the mother of Billy who was bom without arms.
2 Reprinted with permission of Prentice-Hall, Inc., from Karen by Marie
Killilea. Copyright 1952 by Marie Lyons Killilea.
300 Physical DIsabilify — A Psychological Approach
became convinced when he survived a nearly fatal illness that he was born
for a purpose, and as the months progressed increasingly saw the positive
intent of God's work with respect to Billy (Bruckner, 1954).
Religious beliefs serve to organize one's feeling and thinking about
illness and disability through value judgments of right and wrong, of
purpose and ultimate meanings. But it should be clear that values enter
into the scientific approach also. As a matter of fact, as the discussion of
acceptance of disability well testifies (Chap. 5), it assigns to values a
central position. Instead of considering supernatural forces to be a factor
in the causality and meaning of disabling diseases and accidents, however,
science attributes these events to amoral, natural conditions. Human
values, nevertheless, may loom high, and it is the process of reevaluation
that can carry the parent far in giving his child the love, support, and
acceptance needed to face constructively the reality of his disability.
In the account below, a father was able to achieve an emotional and
intellectual acceptance of his son's disability without specifically calling
upon divine judgment. The son. Bill, had lost both arms in a car accident.
The father, in service during the war, wrote his son a letter on the eve of
Bill's discharge from the rehabilitation center:
. . . He told him, in words as simple and plain as those he used in making
his reconnaissance reports, about a man's rights. He said he was fighting in
Korea for those rights, for his own, for Bill's, for Marty's [mother]. "For
everybody's rights, Son, no matter where they live. But sometimes a guy gets
mixed up. You hear so much about rights these days you begin to think you
have a right to everything. Even to a body with two legs and two arms and
sight and hearing and so on. But you don't. No one has a right to that kind of
body. It's a gift. God gives it to you or nature gives it, or you can call it the
evolutionary process, or however you want to speak of it. In big words or
little words, it is a gift. And not everybody is given it. For accidents happen
before birth, as well as afterward. I know a great chap who was born without
arms and legs. . . .
"And sometimes," he said in this letter, "even when we have a gift to begin
with, it gets messed up. You know about that. And I know too, out here,
because it has happened to some of the bravest men I've flown with. It's funny
how a guy can get mixed up about things. He loses a leg, say; or his arms, or
his sight; he begins to feel he hasn't had a fair deal; things are raw; he's been
gypped; somebody's taken his right to a whole body away from him. He's all
wet. Bill.
"But there is a right that you do have; everybody has; and that is the right
to a whole life, whether you have legs and arms, or not; no matter how dif-
ferent you may be. And I mean by a whole life, a life full of fun and interest-
ing experiences (along with the hard things), and people you love, and a girl
some day, and a job you like to do, and sports, and making things better for
others. We are going to do our best. Bill, to help you hold on to that right. To
The Parent as a Key Participanf 301
see that nobody takes it away from you. But you have to walk to it, boy, like
Guillaumet [a pilot who had suffered untold hardships and whom Bill admired].
All your mother and I can do is stand by, and help when we can" [Smith,
i95'^;178-179].3
THE PROBLEM OF HOPE VERSUS STARK REALITY
The presence of a disability brings a special salience to certain psycho-
logical problems common to human adjustment in general. Among these
is the problem of hope versus stark reality, a problem first stressed by
Dembo {1955). The problem will be examined here from the point of
view of the parent; its applicability to the process of adjustment in the
person who has the disability will readily be seen.
On the basis of interviews with parents of children with cerebral palsy,
Dembo has concluded that rather than emphasizing the permanence of a
child's severe handicap, those working with the parent should support his
hopes for improvement. The argument rests on two main points. First, the
harsh, realistic view in the early stage of adjusting to severe disability
leads to despair and the severest suffering. Secondly, hope, however un-
realistic in terms of probability of its actualization, does not necessarily
interfere with the practical and sensible care of the child. On the contrary,
it provides the needed encouragement to continue with the interminable
demands of rehabilitation whereas the recognition of stark reality can so
deplete one's emotional resources as to make one ineffectual in the job
ahead. An important theoretical analysis of the difference between realistic
and wishful expectations in terms of ( 1 ) the assumption concerning law-
ftilness of nature and (2) the focus given to probabilities versus possibili-
ties in the future, is also made in that study.
In regard to the practical working relationship between specialist and
parent, however, the issue of hope and stark reality does not always
provide a ready-made guide. On the one hand a parent may need to hope,
but on the other hand a certain degree of realism is necessary for the
parent to take steps and make plans toward constructive coping. More-
over, hope built upon evasion is hardly reassuring. As indicated in the
study by Davis (1958) of the process of recovery from polio as this takes
place in the interaction of child, hospital, and family, the parent often
needs both more facts and greater support for hope than he gets.
We therefore propose two guiding principles: First, the realistic state
of affairs as it relates to the current welfare and planning of the child
must be discussed with the parent, but even then hope can cast its glow
3 By permission from L. E. Smith, The Journey, copyright 1944, World
Publishing Company.
302 Physical Disability — A Psychological Approach
on the problem. For example, it may be important to convince the parent
that the child is deaf in order that the necessary speech training program
be instituted as soon as possible. The parent may have to be convinced
many times over that current knowledge of surgery and other medical
treatment will be of no avail, but this does not mean that the parent must
discard all hope for medical advance and that the child may eventually
hear.
Secondly, the emphasis given to the reality of the future can be guided
by whether the parent gives indication that he needs and is ready to know
it. In spite of his wishful thinking, the parent does gradually absorb the
reality before him, at first unconsciously, and then with conscious
acknowledgment. Time psychologically prepares the parent. It makes it
unnecessary that he be shocked into reality by the callous words of the
professional person.
The readiness of the parent to face the facts can be paced with less risk
if the parent is given an opportunity to "see for himself." For example,
Cruickshank (1955) has suggested that parents of children who are
mentally retarded as well as cerebral palsied be given the chance to see
their child's progress in a nursery school with other children with dis-
abilities but who have normal mentality, since "clinical findings fail to
convince parents, who cannot be expected to understand the ultimate
implications of a slow rate of development; untold mental anguish and
feelings of guilt of parents can be alleviated if the parents . . . convince
themselves of the failure of their child to respond to educational oppor-
tunities. . . . Realistic planning should ideally allow for this phase of
parent-enlightenment before further planning is undertaken" (p. 347), If
a parent of a deaf child visits a school for the deaf, he may be upset by
the fact that the voices of the graduating seniors are monotonous and far
from what he had hoped could be accomplished, but his reaction remains
one of disappointment and not despair when gradually he has been learn-
ing about deafness.
In short, instead of informing parents of everything at once, it is
proposed that they be taught at a pace determined by their readiness to
assimilate the facts. This does not mean fooling the parents. But it does
mean dealing primarily with the present reality in an atmosphere of
hopeful expectation, allowing the bleak probabilities of the future to fall
into place as the parent seeks and is ready to face such clarification.
Some will disagree with this advice. It may be held that a wound, how-
ever deep, is better when it is clean-cut. The Dembo point of view, on
the other hand, maintains that for the wound to be clean-cut, the area
must first be prepared by the proper presurgical care. If one is grateful
for the bitter truth, it is because one already has been prepared; one
already "knows" and needs the voice of authority to give certainty to
The Parent as a Key Participanf 303
that knowledge, a certainty that provides relief only after floundering amid
the unknown and being exhausted by it. Even then hope is not precluded.
There is one more important point. Not infrequently misconception
and prejudice masquerade in the name of reaUty. When Karen's doctor
told her mother, "I don't believe that cerebral palsy children have any
mentality" (Killilea, 1952:29), he thought he was being realistic and that
*>he ought to know. When another doctor advised the parents to take
Karen to an institution and leave her and forget they ever had her (p. 34),
he also thought he was being realistic. The judgment of reality depends
partly on whose eyes are perceiving. By and large the eyes of the parent
become very good perceivers when he is given time and opportunity to
see and to feel as well as to hope, which gives to that reality a promise for
the future.
Coating reality with hope does not mean living in a world of unreality.
Accepting a disability does not mean banishing hope. Even when one has
reached the most wholesome adjustment to disability — namely, that of
viewing physical normalcy as an asset value — hope is not ruled out.
Secondly, as a general principle, shocking a parent into reality has
doubtful value. As he struggles to adjust to the loss, reality takes shape
before him. But he needs time and experience with the disability to face
it. Although he cannot or ought not live by hope alone, in proper propor-
tions it can be a leavening agent that lightens one's burdens.
These are assertions. Research is needed not only to provide more
substantial support for them but also to shed further light on the balance
between "hope" and "fact" most conducive to ultimate adjustment at dif-
ferent stages in the process of accepting a disability.
THE PROBLEM OF OVERPROTECTION. DEPENDENCE.
AND INDEPENDENCE
In any study of the attitudes and behavior of parents toward their chil-
dren who have some disability, overprotectiveness is likely to appear as
one of the main categories. Research involving children with cerebral
palsy (Shere, 1954), other crippling conditions (Kammerer, 1940), the
blind (Sommers, 1944), etc., well illustrates this. Moreover, the generali-
zation can probably be made that parents tend more frequently to be
overprotective toward their children who have a disability than toward
those who do not. A study of thirty pairs of twins, one twin of each pair
being cerebral palsied (Shere, 1954), revealed that of these, thirteen
children with cerebral palsy were judged to be overprotected, whereas
none of the nondisabled twins was so judged. An enlightening account of
304 Physical Disability — A Psychological Approach
three families differing in their degree of acceptance and overprotective-
ness toward the cerebral palsied child and his twin is also presented (pp.
129 ff.).
The person who has a disability often rejects the overprotection to
which he believes he is subjected. In the Heiders' study of the attitudes of
deaf persons toward those with normal hearing (1941), for example, it is
reported that former pupils of schools for the deaf spontaneously men-
tioned, among other negative interpersonal relations, that deaf people are
overprotected by and lose their freedom to those with normal hearing.
The following excerpt from a tape recording of a discussion between a
teacher and several young adolescent cerebral palsied children shows how
strongly these subjects feel about the need for independence (Sutter,
1954).
Bobby: They [my parents] don't understand that you have to go out and buy
something.
Teacher: I like that, Bobby, they don't understand that you have to get out.
Curtis, you had something to say and I want to hear it.
Curtis: My family babies me too much.
Teacher: Your family babies you too much. . . .
Bobby: My mother won't let me take my own bath.
Teacher: How old are you Bobby?
Bobby: Twelve.
Teacher: And you can walk aroimd pretty well. All right ... we can't
leave this subject without finding out why parents feel this way. Why?
Bobby: They're afraid for you.
Teacher: They're afraid for you. Joe, does your family protect you too much,
take too good care of you sometimes, do you think, or do they let you do
anything that is reasonable, going out to the store and so on?
Joe: She won't let me go to the store because a lot of my streets are danger-
ous and she don't trust me too much.
Teacher: I don't think it's that your mother doesn't trust you. I think she
may not trust your ability to see very clearly or well enough. Well, that's not
distrusting you. Sometimes there are very good reasons for these things. Yes,
Joe?
Joe: Look for a car.
Teacher: Sometimes there are ways and means to get around these things
like taking a bath or going down to the village. If we can work closely
enough with your parents, the teachers and you, we all get together, maybe
some of these problems can be solved. . . .
Diane: After all, you're going to have to do it eventually. You're going to
have to do it when you really are more or less on your own, when you don't
have anybody to look after you you're going to have to do it and if you
can't do it now while your parents are still with you, why then when some-
The Parent as a Key Participant 305
thing happens to them and you try to do it something terrific is liable to
happen to you.*
Now our problem first begins. We have to think through what over-
protection signifies before we dare condemn or commend the "nurturant"
relations of one person toward another. The following are some important
considerations, helpful in the understanding of this concept.
Overprotection Negative by Definition
By its very syntax the term "overprotection" has a negative connotation,
for too much of anything is undesirable. A certain amount of protection
is good; deviation from that optimal amount is not good.
The following behavior patterns have been ascribed to overprotective
parents:
1. They are highly child-centered; they are eager to sacrifice themselves (and
the rest of the family) for the "good" of one particular child.
2. They are continually helping the child, even when he is fully capable and
willing to help himself; they bathe, dress, and undress him; they feed him.
3. Their discipline is inconsistent. There are occasions when they meticulously
adhere to regulations and mete out punishment for the slightest infringe-
ment; at other times, they are overindulgent and lax.
4. They are dictatorial and arbitrary; they make decisions which involve the
child without considering his wishes. Among overprotective parents, those
who are acceptant give lavish toys and tell the child how to play with
them; those who are rejectant withhold gifts and privileges or withdraw
them on the slightest pretext.
5. They hover over him; they offer suggestions; the rejectant parents nag and
criticize; the acceptant parents call attention to the child's every activity
and bestow more praise than is deserved.
6. They protect him from every imaginable discomfort or difficulty, the
acceptant parents because they cannot bear to see the child suffer; the
rejectant parents because their anxiety serves to disguise their rejection of
him.
7. They restrict his play, the acceptant parents because they fear he may get
hurt; the rejectant ones because by their restriction they frustrate and
punish him.
8. They deny him opportunities for growing up; they thwart his curiosity; the
acceptant parents because they want to keep him a baby; the rejectant
parents because they do not want to take the trouble to teach him.
9. They do not understand his capabilities and limitations; they set goals
which are too high for him, or they are content with goals which are too
low.
4 From a tape recording.
306 Physical Disability — A Psychological Approach
10. They monopolize his time; they sleep with him; they allow him few friends
of his own choosing; they take him to parties and call for him; they
persuade him to stay at home with them [Shere, 1954:48-49].
A notion of the equally unfortunate effects imputed to the child who is
overprotected is given by the following manifestations:
1. He is overdesirous of petting and cuddling. He likes to sleep in the same
room with his parents or even in the same bed with one of them. He is
afraid to sleep alone.
2. With younger children he is bossy and aggressive but with older children
or adults he is oversubmissive and docile. He is usually very well behaved
in school.
3. He is cheerful when he is with his parents or anyone with whom he feels
secure but is inclined to cry or be unhappy when he is separated from them.
4. He is overconforming; he obeys impUcitly.
5. He is usually apathetic, but in the presence of strong stimuli he may
become highly emotional. He may have temper tantrums.
6. He has little or no curiosity. He is interested only in matters of which his
parents approve. He shows behavior indicative of insecurity when he is
with children of his own age who are more mature than he is.
7. He is shy and unfriendly to strangers. He does not know how to play with
other children, yet does not like to play alone; he may prefer to be with
his parents; he may like to read rather than to play.
8. He is jealous of anyone who appears to threaten his position with loved
ones.
9. He is afraid in many situations, even where there is no real danger.
10. He is pleased by flattery and depressed by adverse criticism. He con-
stantly asks for assurance of parental favor; he often asks for approval of
what he is doing.
11. He prefers to have help in all his activities and is inclined to reject re-
sponsibility. He does not dress himself or get to school on time without
help.
12. His feeling of insecurity is manifested by nervous habits, which may serve
as emotional releases or as attention-getting devices [Shere, 1954:51-52].
It might appear that, with such explicit criteria as given above, identi-
fication of the overprotective parent would not be difficult. The judgment
as to whether the child is being overprotected, however, depends upon
who is doing the evaluating. The second criterion, for example, states that
the overprotective parent is continually helping the child, even when he is
fully capable. The parent himself, however, generally does not agree that
this is the case. Instead, he is usually convinced that the child is not in
fact fully capable of self-help in the particular instance. As he sees it, it
is the realities of the situation that require his help and protection.
That the label "overprotective" involves a point of view is also seen in
The Parent as a Key Participant 307
other comparisons. The independence given children today would have
been considered excessive by the Victorian parent or schoolmaster. Socio-
economic level also influences standards of protectiveness. The develop-
mental stage of the child is especially important in dictating what does
and what does not constitute overprotectiveness. Not allowing a three-
year-old child to cross a street unaided is sensible, whereas in the case of
an ordinary twelve-year-old it is unduly restrictive. The adolescent tends
to regard any parental guidance as overprotective. Finally, diversity in
appraisal is presented by neighbors who may feel that the parent is under-
protecting his child when he allows his blind or deaf child to cross city
streets, though both the expert and parent may believe that they are build-
ing toward independence.
Glorification of Independence
The problem of overprotection is part and parcel of the cultural value
placed on dependence and independence. A notion of how American
middle-class society compares in this respect with other societies is pro-
vided in the important study of child-rearing practices by Whiting and
ChUd (795i.Chap. 4).
1. Initial nurturance. Among the 38 primitive societies rated, indul-
gence of the infant's tendencies to be dependent is generally rather high.
This is also true of American middle-class society, though 30 of the
societies allowed their babies to be more dependent than ours.
2. Age at beginning of training in independence (self-reliance, re-
sponsibility). The median age at which serious efforts at independence
training are begun for the 38 societies is a little above 3.5 years, American
middle-class society being placed at 2.5 years. However, independence
training among the American group is completed at a very late age in
comparison with the societies rated.
3. Severity of independence training. American middle-class practice is
placed at the median of all the societies surveyed, a high rating being
given, however, for that aspect of independence concerned with the
responsibility of the child for taking an adult role in the household
economy (e.g., self-help in dressing, chores) and a low rating for fending
for oneself without adult surveillance. The evidence further indicates that
in regard to overall indulgence and severity of training as applied to a
variety of behaviors (nursing and weaning, toileting, sex behavior,
dependency, aggression), American middle-class society is comparatively
not only extremely low in average indulgence but is also rather extreme in
the severity of its socialization practices.
308 Physical Disability — A Psychological Approach
A major study by Sears, Maccoby, and Levin (1957: Chap. 5) con-
tributes additional data on dependency in American children. Almost 400
mothers of kindergarten children were asked how much attention her
child seemed to want, whether he followed her around, whether he
objected when she left him for a while, and whether he asked for un-
necessary help. On the basis of these indications of dependency, it was
found that by the time the children were five years of age, a preponder-
ance showed little of the dependency behavior rated; only about 20 per-
cent showed a considerable amount (Table D:13, p. 524). There was,
however, a wide variability in the attitudes of the parents toward the kind
of dependent behavior investigated. About one-third showed little toler-
ance for such dependency; the middle third was moderately permissive,
and the remaining third was lenient.
Taking the various lines of evidence into account leads to the conclu-
sion that independence as a global, emotional ideal is highly valued in our
society. It goes along with strength, masculinity, leadership, rugged indi-
vidualism. Dependence, on the other hand, is often disvalued. It is asso-
ciated with weakness, femininity, indecision, selfishness, and helplessness.
No one would be startled to find a book or a chapter entitled "Growing
toward Independence" but one would be rather surprised to find the
headmg "Growing toward Dependence." The shock might be tempered by
the assumption of a typographical error, or that the chapter dealt with all
the bad things which lead children to grow in the wrong direction. If the
author argued that children and adults need to grow toward i/^pendence,
would the reader take him seriously?
This hypothetical situation indicates how deeply rooted is the convic-
tion that independence as a goal has the weight of an axiom. Add to this
the fact that disability may threaten independence and we have a combina-
tion of circumstances that makes understandable, if not completely justi-
fiable, the tremendous emphasis placed on independence in work with
persons who have a disability.
As long as dependence is arbitrarily disvalued and neglected in inter-
personal relations, independence becomes distorted as a goal. What
happens, for example, to the warmth and friendliness between parent and
child when the parent is imbued with one mission — namely, to get his
child to eat alone, dress alone, walk alone? There is no doubt that these
are important goals, but when independence becomes virtually the domi-
nating guide for parental behavior, the cost in emotional security is un-
justifiably great. This is seen in the following example of a mother who
insisted on self-reliant behavior in her five-year-old child:
1[nterviewer]: How did you feel about it when she wanted to be with you
all the time?
The Parent as a Key Participant 309
M[other]: Well, I had to teach her she had to be alone at times and not
have me around.
I. How do you generally react if she demands attention when you're busy?
M. I don't pay attention to her.
I. How about if she asks you to help her with something you think she could
probably do by herself?
M. I tell her she's supposed to do it herself, and I'm not going to help her.
I. And then does she do it?
M. Oh, yes, if she feels like it.
I. Otherwise, what do you do?
M. Otherwise, I just let her alone, let her have one of her stubborn streaks,
or just take things away, tell her she can't play any more if she's going to be
like that [Sears, Maccoby and Levin, 1957:164].^
This is the kind of overriding pressure that independence as a dominat-
ing goal can exert. It is the kind that destroys the essentially human
quality of a relationship.
Several research findings are pertinent here. In the study of children
with cerebral palsy mentioned earlier (Shere, 1954), the children who
were both loved and overprotected, but not those whose overprotection
stemmed from rejection, appeared to be friendly, cheerful, with a good
sense of humor, and free from aggressive behavior. In the study of pat-
terns of child rearing by Sears, Maccoby, and Levin (1957) it was found
that:
Punishment for dependency only made children more dependent than ever.
Withdrawal of love as a disciplinary technique and severity of punishment
for aggression toward parents were significantly related to degree of child
dependency.
Those mothers who had an accepting tolerant attitude toward the child's
dependent behavior tended also to be affectionately warm toward the child,
gentle about toilet training, low in their use of physical punishment, high in
sex permissiveness, low in punishment for aggression toward parents, and high
in esteem for both self and husband.
The findings of these two studies alone suggest caution in decrying
dependency (or for that matter overprotection) without considering the
broader relationship between parent and child, the emotional needs of the
child, and the ways of achieving a satisfactory dependence-independence
balance.
A great step forward was made when psychoanalytic and other theories
stressed that the early period of dependence of the child on his parents
5 R. R. Sears, E. E. Maccoby, and H. Levin, Patterns of Child Rearing,
copyright 1957. By permission of Row, Peterson & Company.
310 Physical Disability — A Psychological Approach
is important and that the need for nurturance in its broadest sense must
be satisfied. Emotional support for this emphasis was given by the strong
cultural and human value placed on love and acceptance and by the
anxiety about social rejection, which is especially strong in our culture.
Nevertheless, dependency as such is usually not posited as a desirable end
in itself. Instead, it is seen as a means to emotional security or to ulti-
mately greater independence.
We should like to extend the emphasis on dependency by submitting
that dependence in itself is a value, that it is essential in many important
kinds of interpersonal relations. A person should be able to rely on others,
to ask for and accept help, to delegate responsibility, but these relations
occur naturally only when the person has "learned" how to become
dependent or, what may sound better, has learned that there are many
occasions when dependence is indeed laudable. Dependence becomes then
not a second-best alternative but a valuable end in itself. The physical
reahties of life as well as the needs of psychological man require that he
be dependent on others as well as independent of them. And this holds
true for the adult as well as for the infant.
But, it may be protested, independence guarantees future security; to
the extent that one can do things by oneself, one becomes independent of
what, after all, are but transient relations among men. The counterargu-
ment is that independence is also but a transient state. One does become
sick, disabled, and old, states that do require interpersonal dependence.
Even in the optimal state of health, family members, citizens of a com-
munity, mankind as a whole, are interdependent. An important lesson can
be learned from the realization that if, instead of heightened nationalism
and the struggle of each country toward complete independence, a one
world of cooperative nations would emerge, the gains to humankind as a
whole would be unfathomable. But this presupposes that dependence and
interdependence are respectable facts. So it is with individual man. Inde-
pendence cannot be upheld as a value without the framework of sound
dependency needs.
And just as people may be excessively dependent on others, they may
also be excessively independent of others. In both instances the person is
denying to himself and others certain values that could accrue through a
healthier balance between dependence and independence. Excessive
dependence denies the obvious value of freedom and ability to do for one-
self. Excessive independence denies the less accepted value of emotional
sharing and a readiness to rely on others and to delegate responsibility.
It also may wear a person out. Being goaded by independence, he may
insist on doing for himself only to be depleted of energy and emotional
resources that might well have been spent more usefully. Glorification of
The Parent as a Key Participant 31 I
independence must give way to an appreciation that independence and
interdependence go hand in hand.
This principle suggests a new look at parent-child relations. It suggests
that parents, through the pressure of their own principles and those of the
specialist, may be pushing children too fast and too soon toward the vague
and abstract goal of independence. It suggests that the priceless quality of
warmth in interpersonal relations may be usurped by the calculated zeal
to teach the child independence. It suggests that ratings of overprotective-
ness, which appear as central findings in research reports, may be unduly
weighted by the high cultural premium placed on independence. It sug-
gests the need for investigation of the kinds of dependence that should be
fostered during the various phases of the entire life span of a person's
development.
There are numerous specific guides as to what we may expect in the
way of independence at various age levels. The Vineland Social Maturity
Scale itemizes the kinds of activities that the average child can be expected
to accomplish independently at various ages — e.g., goes to bed unassisted,
makes minor purchases. There are some items that deal with dependency
relations, but very few of them. If a child has the capability for inde-
pendent activity but has not achieved this, we know where help may be
applied. Thus: "Cerebral palsied children are seen who have reached ages
of one and one-half to two years who are capable of learning to sit and
are not sitting except to be propped in the corner of a heavily upholstered
chair or divan" (Snell, 1955:289). But we do not have a scale listing the
kinds of maturing dependency relations at various age levels. And we do
not often find statements to the effect that a child needs help along
specific lines to enable him to become more dependent on another. The
"do-it-yourself craze" may apply just as aptly to interpersonal relations as
it does to material constructions.
Specific Aids in Achieving the Dependence-Independence Balance
It has already been pointed out that the judgment of overprotectiveness
varies not only with the person making the judgment but also with the
signs of the times. Although this implies that there are no universal
criteria as to how much is too much and not enough, there are some aids
to the parent in arriving at what is for him a satisfactory course to take
in the specific teachings of his children.
The opportunity for parents to observe other children with the same
disability as that of his child, so that he can learn what various children
are able to do and what they are allowed to do, opens up new possibilities
to the parent. Where children with particular disabilities gather together.
312 Physical Disability — A Psychological Approach
as in a special preschool, special school, or special class within a school,
this opportunity is easily provided.
Extended awareness of what can be realistically expected of the child
also emerges through participation in parent discussion groups.^ More
and more "Institutes for Parents" are being organized on a statewide basis;
here parents facing some of the same problems involved in the disability
of their children gather for several days to learn, with the aid of specialists
and through each other, how best to help their children. The point can-
not be overemphasized that parents frequently hold their children back,
overprotect, and indulge them, because they simply are not aware of the
possibilities for doing otherwise. In observing other children and in ex-
changing ideas with parents and specialists, such reorienting notions may
emerge as: "I think my [blind] child wiU be able to ride a trike too." "He
[cerebral palsied] could lace his own shoes if I'd give him enough time."
"I will let my [deaf] child go to the store. The grocer will be able to
understand him." And on the side of accepting or developing dependent
needs: "My child is too aloof from others. He needs to play more with
other children." "My child always wants to be the leader. He should play
a little with older children so that he can enjoy following." "My child is
afraid to ask for help. I wonder why." "My child is such a mama's boy.
Maybe it's because I didn't have enough time for him, what with the
new baby and all. . . ."
Because comparisons are often somewhat dangerous, we should like
once again to interject a word of caution. Although the gains from paren-
tal interchange and observation of other children are many, they may be
offset by the ill-considered adoption for one's own child of standards based
on what another can do. Even though another child has a similar dis-
ability and is of the same age, the principle of individual differences, of
course, still holds. But because parents seek the fulfillment of the highest
aspirations for their children, there is a strong tendency to take over as a
standard the performance of the superior child in the group. Here the
parent can use the guidance of the specialist. He needs help in under-
standing the abilities and limitations of his child as an individual.
The parent also needs to be informed of special techniques that can aid
in the development of his child. Many of these require very little in the
way of mechanical equipment. As Lowenfeld (1956) points out to parents
of blind children: "Your child, if he is totally blind, may not be familiar
with the way in which legs must be moved in walking since he cannot see
it done. You can help him easily in this situation. Let him stand on your
^ General principles for organizing and leading such groups appear in Bice
(7955). A study of parent groups for children with handicaps is reported by-
Levy (1952).
The Parent as a Key Participant 313
shoes while you hold him by the hands. Thus he will be able to observe
with his own body your movements when you walk. This should be done
in such a way that your child faces the same direction as you do in walk-
ing. If you do this frequently enough while he is gaining control in stand-
ing up, he will one day step oflf your shoes and go through the actions of
walking himself" (p. 53).^ The suggestions outlined by Snell (1955) are
simple and beneficial: "Parents [of cerebral palsy children] complain that
their children do not like to sit in a high chair or that they slide down in
the chair, and after a few attempts . . . the high chair is discarded.
Adjustments can be made in high chairs, such as reducing the length of
the back legs slightly, so that the front of the chair is higher than the
back. A piece of wood two inches wide and four inches high may be
attached to the center front rim of the seat on the high chair, this padded
and covered with a plastic material, so that it can be easily cleaned. The
child is placed in the chair with a leg on either side of the bar so that it is
not possible for him to slide out . . ." (p. 289). The importance of
informing parents of "know how" would hardly require mention if it were
not for the fact that simple solutions and aids are often overlooked in
rehabilitation requiring such complex procedures as bracing and special
education.
The idea of creating opportunities for specific kinds of experiences
should also be raised with parents. Although this is obvious as a principle,
parents need help in applying it concretely. Again an example from
Lowenfeld (1956) is apt. We do not have to think very much about op-
portunities for moving and exploring for the ordinary child, for on his
own he will expand his horizons beyond his own body, from his crib to
his play pen, his room, house, yard, and neighborhood. But in regard to
the blind child, or the child with marked physical incapacity, indifference
on this score will markedly impede growth and development. "The blind
child will often remain unaware of his environment and of interesting
objects in it because he cannot see them, and his other senses do not make
him conscious of them. Therefore, he will often need to be taken to
things, or from one place to the other before he will venture out on his
own. But he is just as eager to move and explore as any other child if he
is stimulated and encouraged in ways which are suitable for him" (p. 17).
The creation of opportunities applies, of course, not only to locomotion.
A common-sense through fallacious notion regarding deaf children, for
example, is that since the child cannot hear it is futile to talk to him;
instead, one must gesture. The parent's realization that the child must be
spoken to so that he may develop speech-reading skills represents a major
7 From B. Lowenfeld, Our Blind Children, 1956. Courtesy of Charles C
Thomas, Publisher, Springfield, 111.
314 Physical Disability — A Psychological Approach
step forward. Not only must the parent talk to his child when interacting
with him, but it is also desirable that the opportunity be created for
persons not of the family to communicate with him.
Invoking situations in which the child can assume responsibility com-
mensurate with his abilities will also aid his growth toward mature in-
dependence. It hardly needs mentioning that independence unbridled by
responsibility lacks the necessary guidelines for effective use. A child may
learn to cut his meat with his knife, but if he has to be watched every
moment lest he also cut up the tablecloth, his level of independent func-
tioning will be seriously restricted. On the other hand, a child who does a
trustworthy job of feeding his pets or of planning a birthday party is at
the same time building up feelings of responsibility, self-esteem, and
confidence, all of which count in the progress toward a mature depend-
ence-independence balance.
Opportunities for increasing responsibility must be thought about and
planned for all children, and particularly for children with major handi-
caps. One has to guard against two insidious tendencies — namely, the
tendency to see a child who has a severe disability as severely disabled in
all his functioning (see pp. 118-119) and the tendency to yield to the fact
that it is often much easier — from the short-range point of view, at least —
to limit his scope of activities than to enlarge it to include real responsi-
bility. In an important ecological study by Barker and H. Wright (1955)
in which an institution for cerebral palsied children was compared with
a nearby rural community, one of the sharpest differences found was that
the institutionalized children entered far fewer positions of responsibility
and status than did the rural children. Relatively rarely were they leaders,
joint leaders, or responsible functionaries in a particular setting. More
typically were they onlookers or participants with little power in the
situation. Children need to become the main actors in some of the home,
school, and community settings, and not serve only as auxiliary players.
Parents (and schools) need help in recognizing those naturally occurring
situations that are well within the child's command, and in devising others
where they do not exist.
The creation of opportunities is not always easy to effect, even though
awareness of the child's needs often does suggest simple solutions. The
parent may realize how important it is for his cerebral palsied child to
have experience with a variety of adults and may look for a baby sitter to
provide this opportunity, only to have considerable trouble in finding a
person who is willing to undertake this duty. Or the parent may be aware
that his child needs the companionship of other children, but, in spite of
his efforts to provide interesting play situations for invited children, he
may sense a reluctance on the part of neighbors to encourage this. The
children themselves may prefer other outlets for their play time. The
The Parent as a Key Participant 315
rehabilitation worker must be aware that even with the best of intentions
solutions sometimes are "easier said than done." Follow-up is necessary to
correct the false leads and seek solutions in other directions.
Finally, the judicious use of reading material (see pp. 298-299) can be
invaluable in imparting to the parent constructive attitudes and factual
information, the background necessary toward realizing a healthy balance
between striving for independence and striving for dependence.
Parental Attitudes Underlying Overprotection
Because all of us are eager to attach specific causes to specific behaviors,
the counselor needs to remind himself that overprotection is an ambiguous
symptom. It can stand for such different underlying emotional relations
between the parent and his child that by itself it offers no clues to the
innermost thoughts and feelings of the parent. A good deal more informa-
tion about the parent's attitudes is required before the overprotection can
be understood and most effectively modified. Some of the more common
underlying feelings that can find expression in overprotection are discussed
below.
Genuine Love and Concern for the Child. Love and concern for the
child do not necessarily constitute the most important or the most likely
basis of overprotection, but all too often they are entirely disregarded.
Reasons for this disregard may be found in the strong current tendency
to perceive only negative relations between parents and children; in the
fact that unhealthful relations trouble us, not healthful ones; and in
the cognitive principle that it is easier to relate a negative effect (over-
protection) to a negative cause (rejection) (Heider, 1944). Nevertheless,
a parent may enjoy doing for his child and want to do as much as he can,
not realizing that the "doing for" may in the long run be "doing against."
Add to this a real concern about the child within a complex emotional
setting and we have a relationship, albeit warm and loving, which is con-
ducive to overstepping the optimal range of protectiveness.
Guilt. Guilt provokes compensatory behavior — i.e., a person atones
by making up for the presumed wrongdoing to the other. If a parent feels
guilty, therefore, it is understandable that he may indulge his child and
continuously protect him from real and imagined dangers. The parent
may feel guilty because he basically rejects the child, dislikes and even
hates him, and would rather be rid of responsibility for his care. He may
feel guilty because of a belief or unconscious feeling that he is responsible
for the child's disability. His guilt about the child may be a displaced
guilt, the experiences originally instigating it being far removed from
consciousness and the current scene.
316 Physical Disability — A Psychological Approach
Need for a Dependent Child. To feel needed and wanted may so
dominate the pursuits of some parents that only by keeping the child in
an infantile relation to him is the parent guaranteed security. Such a
parent will tend to magnify the disabling aspects of his child's disability
and the dangers of the world. Every time he does something for his
child he is reassured that he matters to someone. Every time the child
makes a step forward toward independent management, a twinge if not
a pang of regret is the conscious symptom of fear that he himself is being
left unneeded by the wayside.
Impatience. Not to be overlooked is the fact that during the begin-
ning stages of learning it often requires a good deal more patience on
the part of the parent to stand by and let the child do for himself in his
own inefficient and sometimes work-producing way than for the parent to
take over. This point has been stressed and realistically exemplified as
follows: "More time and patience is needed to allow a child to dress him-
self who has difficulty using his hands and poor standing ability. The
mother must be around to do the one or two things he cannot do, such as
put on the trousers or fasten the buttons, and she may have poor tolerance
for waiting around. Cleaning up after a child who eats his meals in a
messy way is more work to a mother than feeding him, so she may pro-
crastinate in letting him feed himself. ... A great deal of resourcefulness,
imagination, patience, and self-discipline is required to maintain a happy
medium" (White, 1955:419). Sometimes impatience is an expression of
rejection of the child. Sometimes the parent is simply not aware that
progress is made slowly. And sometimes the parent is already over-
burdened with emotional problems or with the time and energy demands
of homemaking.
Some specific aids toward achieving a "happy medium" between in-
dependence and dependence have been discussed above. It v/ould seem
that these would have the best chance of being eff"ectively utilized where
love is the prevaiHng underlying feeling, for then the predominant effort
of the parent, consciously and subconsciously, is geared toward the child's
needs, not the parent's. Guilt and a need to keep a child dependent, on
the other hand, instigate behavior that is basically parent-centered, not
child-centered. If the parent is driven by these feelings, the kind of
emotional reevaluation necessary before a comfortable relation between
the child and the parent can be reached may require the services of a
psychotherapist. Parent discussion groups can, however, do much to help
the parent become aware of his feelings. Hearing a disquieting attitude
talked about in a socially permissive atmosphere makes it easier to see it
in oneself. As one father participating in a discussion group said, "If
anyone had asked me before it was mentioned here if I ever felt guilty
about our boy, I would have denied it: I realize now that I did" (Bice,
The Parent as a Key Participant 3 1 7
1950) . Not to be overlooked is the fact that good feelings also may come
through to consciousness as a result of sympathetic discussion. Some
parents may be so bothered by their shame and guilt or by problems
extraneous to the child that they have no idea of the real affection and
closeness they feel toward the child.
As for the problem of impatience, all parents, some more, some less,
experience this. The specific aids again can be a real help, for in observing
other children, in sharing attitudes with other parents, in learning specific
techniques of management, the parent also achieves a better perspective
as to what really counts. The unmade beds may become less of a threat
to the mother's status as a housekeeper and more of a sign that she is
taking time with her children. "Make haste slowly" may become a mean-
ingful guide in her relations with her children. Impatience, after all,
flourishes when the person feels he must be on to other things.
At the same time it must be realized that a parent can do only so much,
beyond which excessive impatience and other signs of psychological stress
become inevitable. By the time one carries out the specific procedures
recommended in the home rehabilitation plan, one sometimes has con-
sumed the better part of the waking day. Especially where the parent is
counseled in assembly-line fashion by the speech therapist, the physical
therapist, the occupational therapist and orthopedist, the psychologist, and
social worker is there a great likelihood that the total program will be
unrealistic in terms of the time and energy demands on the parent, to
say nothing of the child. A desirable balance is more readily assured when
the several aspects of the rehabilitation plan are integrated by all parties
concerned, including the parent.
One should note that no matter what the parent does he will be
criticized by some people. Parents need to be prepared for this. There will
be neighbors and friends who will view necessary care and concern as
signs of oversolicitude. More frequently there will be those who will
interpret as neglect and rejection the efforts of the parent to emancipate
his child by encouraging him to do and learn by himself. Even well-
meaning friends will not be able to understand the mature calmness of a
parent toward his child's disability. In not understanding, they are prone
to be accusing.
Chapter
Motivating Children in the Rehabilitation
Program
How TO GET A PERSON TO DO WHAT HE IS SUPPOSED TO DO AND LEARN
what he is supposed to learn? This is the problem of motivation and deals
with incentives, rewards and punishments, goals and subgoals, success and
failure, values and meanings and much more. Although our discussion
will be focused on children in "rehabilitation situations," the principles
extracted apply to learning in general and to older age levels as well.
REHABILITATION EXHIBITS
Below are presented three records of minute-by-minute observations of
children involved in some phase of rehabilitation. These were gathered
by trained observers in the ecological research on child development by
Barker and H. Wright in the years 1948-1951 (1955). Because of the
unusual opportunity to study "on the scene" problems of motivation, they
are presented here fully. The first is an 8-minute record in which Wally's
mother attempted to get Wally to put on his braces. The second reports a
35-minute session between Ben and his physical therapist. The third is a
10-minute account of Lila participating in a speech therapy class. It is
suggested that the factors in the situation which interfere with the learning
process and those which are conducive to it be noted as the records are
read. Later these records will be drawn upon to exemplify principles that
make a difference in the readiness and willingness with which a person
undertakes the task of learning.
Wally, His Mother, and His Braces
Wally is a 4-year-old boy who is unable to walk as a result of polio-
myelitis which occurred some two years earlier. The scene opens at eight
o'clock in the morning with Wally sitting on a big chair in the corner of
the living room, hunched over, with his face on his hands:
318
Motivating Children In the Rehabilitation Program 319
I'l Wally's mother went directly to stand in front of Wally's chair. She said
gently, "Let's get dressed, Wally." Wally made no move to change his position.
He sat with his head down on his arms. His mother picked up a T-shirt and
said pleasantly, "Put your arms up, Buddy. Don't you want to get dressed?"
Again Wally made no response; he just sat there, hunched up. His mother,
encouraging him, said, "Hurry," as she pulled off his pajama upper quickly
with no cooperation from him. His mother, with a little more urgency in her
voice, said, "Put your arms up," as she held out the T-shirt. Rather reluctantly
and in response not only to her words but also to her hands, because his mother
put her hands on him and helped to lift up his arms, he put his arms up. At
first he was languid and then he stretched, as if he rather enjoyed the stretch.
His expression as he lifted his face a little was disgruntled and sleepy. His
mother shpped the T-shirt over his head quickly, and gave it kind of a firm
pull over his head. Wally said, "I don't hke this," in rather a whiny voice. (He
seemed to refer to the tight T-shirt being pulled over his head.) His mother
admonished mildly, "Wally," and obtained his cooperation. When he had his
T-shirt on, his mother held him under the arms, and stood him on his feet. She
suggested as she did so, "Hold onto me." He held on, but weakly, so that he
wobbled. She quickly and quite efficiently pulled his pajama pants down over
his seat as he was standing.
2' She admonished him again for his general limp behavior and lack of
cooperation by just saying, "Wally," in a mildly reproving voice. As soon as the
pajama pants were slipped over his seat, she picked him up by the arms and
put him back on the chair with his feet sticking straight out. Then she pulled
off his pajamas over his feet. He already had on his shorts; they were under his
pajamas. (Whether he regularly wears them under his pajamas or whether he
had been partly dressed before I arrived, I don't know.) She picked up his
socks and quite hastily put first one sock on and then the other. Wally braced
his back as she put on his socks, but was still very limp in his head and
shoulders.
3' His mother picked up from the floor a high shoe with the brace attached
and started to put it on Wally's left foot and leg. The brace extends the full
length of his leg with a curved part just under the buttocks. Wally immediately
responded to this by saying vehemently, "I don't want to wear that damned old
brace," in a very negative voice. His mother ignored this and went on putting
on the shoe and the brace. He said, "I ain't gonna wear this old brace," with
more vehemence and some defiance. His mother said mildly, "You don't have
to wear them long," then explained, "I have to clean your shoes first, and then
I'll put your shoes on." Argumentatively Wally said, "You did clean my shoes
the other day." His mother smiled at that, partly to me, implying that cleaning
them the other day would not mean that they were clean now, but she didn't
nrgue about it with Wally.
4' His mother continued to lace up the shoe and fasten the brace. Wally
said, whining now, more than belligerent, "I hate that brace," though still
- Time notation, the first minute.
320 Physical Disability — A Psychological Approach
somewhat defiant. As she fastened the brace up high, he put his hand around
and rubbed his hip at the place where the brace hit and said crossly, "I hate
you." (This referred to his mother for insisting he wear the braces rather than
to the braces, I felt.) And then he said, equally unhappy about everything, "I
don't like that lady," meaning me. (I felt that I was included in his general
unhappiness rather than being the cause of it.) His mother responded in quite
a joking way, "You're in a bad mood, ain't ya?" trying to get him a httle bit
out of it.
5' She continued, saying, "You wouldn't let your daddy see you in such a
bad mood, would you?" a little bit jocular, still trying to get him out of it.
Then she added, "Where did your daddy go this morning?" (I think she was
trying to engage him in conversation to get him out of his negative mood.)
Wally said very negatively, "I won't tell you." Then his mother said something
about going where there was a big red barn. Stubbornly, Wally said, "I won't
tell her where my daddy went." (I think he sensed that his mother was trying
to get him to talk partly for my benefit and he was not going to cooperate. He
sounded as though he were hanging onto his bad humor and not that he was
really very upset.) His mother remarked that his daddy would be home for
lunch. As she was talking, she put on his right shoe and brace and fastened it.
Wally whined in a very complaining voice, "These hurt me." His mother
continued to fasten them without responding.
6' Wally more belligerently said, "And I ain't gonna wear them." He turned
and looked at me for the first time, scowling. (The paper boy opened the door
and laid the morning paper on the chair near the door.) Wally did not appear
to notice him. He again whined at his mother, this time a little more as though
he were pleading with her, as though he could make some progress, "Mamma,
I don't want them on." His mother said conciliatorily, "I'll take them off after
a while, after you've had breakfast and play a while." He responded quite
argumentatively, "No, you won't." She put his feet in overall legs. His mother
took his hand and pulled him to his feet. Now, with the braces on, he could
stand with very Uttle support. He held on to the chair or his mother all the
time. She pulled his overalls over the braces and took out some suspenders. She
sat in the chair and he stood in front of her as she fastened his overalls. She
started to fasten the suspenders onto the overalls. (He was completely passive
in all this dressing procedure and he didn't offer any assistance at any time.)
7' As he stood, he whined, "These braces are too heavy, I don't want them."
His mother, a little reproving said, "Wally," meaning probably that he shouldn't
fuss so much. Wally responded by exclaiming, "God, I don't want them." Then
again more belligerently, "I'm gonna throw them in the river." Wally alternated
between pleading with his mother and denouncing his braces. His mother
responded, "I don't like them either. All right, when shall we do it?" meaning
when shall we throw them in the river. (Her voice was joking; I don't believe
he could have believed seriously that she would let him throw them in the
river. It was more an effort to go along with his mood.) She added, "Next time
we go across the big old river, shall we throw them in?" Wally made no
response to this.
Mrs. Wolfson continued with an attempt to change the topic of conversa-
Motivating Children in the Rehabilitation Program 321
tion, "Did you see Jack bring the paper?" Wally did not answer. As he stood
in front of his mother looking sleepy and disgruntled, she turned him around
so that she could fasten the suspenders in the back. Then with that she was
finished dressing him and said, "Okay," indicating that she was through.
She stood up and came around in front of him and took hold of one hand.
He took half a dozen steps toward the kitchen as she held the one hand and
walked backward toward the kitchen. She held out her other hand, possibly so
that she could take both his hands and give him more help. When his mother
put her hand out for his other hand, he made no response. But he stood there
limply with his shoulders bowed and his head down. It seemed as though,
except for the braces, he would crumple in the middle, too. Then she let go of
the hand she held and held out both hands to him as one does to a baby to
lure a baby that's walking, to come to you. At that he smiled for the first time,
a sweet smile, at his mother. He leaned forward and fell into her arms.
8' She picked him up with a swish and carried him halfway across the
room. She put him in the chair at the east end of the dining table in the kitchen.
He sat with his legs straight out, his back against the back of the chair. The
chair was well pushed in to the table. The table had a cloth on it and a clear,
plastic cover over the cloth.
Maud, the two-year-old sister, was in the kitchen now, waiting for her
breakfast. Maud said, "That's what I want," concerning some food. Wally
immediately answered in a cross, grumpy voice, "I'm going to eat them all up."
Maud whined, "Buddy's going to eat them all up." His mother said, placating
Maud, "Oh, no, he won't." And Wally said, "Yes, I will," teasing Maud. Maud
continued to whine about how Buddy was going to eat them all up.
Wally continued to be irritable and uncooperative for several minutes
more until dabbles of sugar and a hearty breakfast made him considerably
more cheerful. The braces remained on for about an hour and a half,
during which time Wally ate breakfast and then played actively and
happily outdoors with his wagon and two cousins. At 9:20, 17 minutes
before the braces were finally removed, Wally for the first time asked his
mother to take them off. His mother replied warmly from the kitchen,
"Well, just a minute, baby." At 9:28 Wally repeated his request, more
imperiously this time, and his mother responded promptly, "Okay, just a
minute." At 9:37, a final pleading from Wally brought his mother out of
the house with a pair of shoes without braces.
A Physical Therapy Session with Ben
Ben is a 6-year-old child with cerebral palsy who has been a resident in
a school for cerebral palsied children for two years. He speaks with
diflficulty and is not yet able to crawl or to stand alone. "In the charac-
teristic picture of Ben he is seen strapped in a chair with his arms hanging
at his sides, his head tilted to one side, his mouth open, and his tongue
322 Physical Disability — A Psychological Approach
hanging out and drooling spittle on his chin" (Barker and H. Wright,
1948-1951). It is early afternoon. Ben had just been brought into the
physical therapy room: Mr. T. is the physical therapist, Miss O. the
occupational therapist, and Celestia an older child with cerebral palsy:
r Mr. T. came over from working with Celestia to Ben. As he did so, he
said in a very cheerful, pleasant, yet business-like way, "O.K. Brother Benrod."
Ben made no response that I could see. Then Mr. T. unstrapped Ben from his
chair, picked him up and laid him down on the floor. Ben seemed to accept this
as just what he had expected; he displayed no particular feeling about it.
Noticing that Ben's shoelaces were unfastened, Mr. T. commented gaily and
in a slightly teasing way, "How come your shoelaces are all undone?" Ben
mumbled quite happily, "I didn't do it." Mr. T. replied in a gay, joking and
nonchalant way, "Oh, I know, I know. You didn't do it. You never do it." Then
Ben said happily, really enjoying himself, "Elmer did it." Mr. T. laughed
restrainedly and said knowingly, "Oh, Elmer did it, huh? Yeah, Elmer always
does it."
2' Mr. T. continued working with Ben's shoelaces. Benjamin talked gaily
away to Mr. T. who seemed to be paying very little, if any, attention. Since he
was not looking at me it was impossible for me to understand what he said.
Apparently Mr. T. didn't understand either, for at one point he said ques-
tioningly, "Huh?" Ben mumbled something else still quite gaily, but I couldn't
understand what he said.
3' Celestia came over and said something to Mr. T. and Mr. T. replied to
her question. Benjamin made no response nor took any notice of this inter-
action. Mr. T. continued lacing Ben's shoes. Then Benjamin said something
else to Mr. T. I didn't understand what it was but I felt sure that it was just
pleasant conversation.
Mr. T. said somewhat more seriously but still in a pleasant way, "How far
are you going to crawl today?" Benjamin mumbled something which I couldn't
understand. I couldn't tell for sure whether he was responding to Mr. T.'s
question or not.
4' Mr. T. finished with Ben's shoes and said gaily, "There you go!" Then
Mr. T. picked Benjamin up from the floor. He stood him up for just a moment
and then placed him on the floor on his hands and knees. Mr. T. had a little
trouble getting Ben settled in this position. He moved Ben's hands close together
and straight out in front of him. He moved Ben's legs so that he sat in a frog-
like position on the calves of his legs and his feet.
5' Miss O. walked in from the Occupational Therapy room and made a few
gay, happy, cheerful remarks about the fact that Ben was going to be six very
soon. Ben looked up at her but made no other response. Then Mr. T. said
somewhat seriously, "Well, any little boy who's going to be six is going to
have to learn to crawl." With this Miss O. and Mr. T. walked to the far end
of the room. Ben did not try to say anything in response to the comments by
Mr. T. and Miss O. but I'm sure he understood what they said. He sat on his
hands and knees, jerking somewhat rhythmically, wiggling shghtly, apparently
Motivating Children in the Rehabilitation Program 323
trying to keep his balance. Ben had been placed on the floor just about in line
with the doorway into the kitchen. It was a distance of nine or ten feet to the
north end of the room which was established as Ben's goal in his crawling. Ben
continued to sit on his hands and knees in this froglike fashion and seemed to
be trying to balance himself. (Miss O. returned to the Occupational Therapy
room without further comment and Mr. T. began talking with Celestia. Ben
paid no attention to them.)
6' Ben continued sitting in this froglike position. He continued balancing,
wiggling slightly as though he might be trying to crawl, although it wasn't clear
that this was what he was trying to do. Mr. T. looked over from where he was
working with Celestia and said pleasantly, with no irritation or impatience,
"Come on, Ben. Let's go." Ben made no response. He continued his rhythmical
jerking and wiggling.
7' Ben's face assumed a very serious look. He began jerking harder and
wiggling more rhythmically as though he were trying earnestly to crawl. (Mr.
T. continued talking with Celestia. Ben paid no attention to them at all.)
Then Mr. T. looked over at Benjamin and said with more insistence in his
voice, "Come on, Ben. Crawl. Lift those knees way up. Now, your left knee,
then your right." Benjamin made no verbal response but it seemed that he tried
a little harder, shifting his weight so that he could slip a knee a fraction of
an inch forward. So far Ben had not moved more than one or two inches from
where he began.
8' Celestia, taking up Mr. T.'s previous comment, said, "O.K. Benny. One,
two," meaning that Ben should move his legs in a steady, rhythmic fashion.
Her comment was very pleasant and cheerful and was not a demand of any
kind. Ben, as far as I could tell, made no response to Celestia's remark. He
continued his efforts to crawl. Again Celestia said quite pleasantly, "Come on.
One, two." This time Ben looked over at Celestia and mocked her saying,
"One, two," imitating Celestia's tone of voice. Then Ben grunted and whined
just a little and tried to push himself forward along the floor.
9' Ben wiggled and bounced quite hard again. His face screwed up into a
deep frown. He whimpered as though he were almost ready to cry. Celestia
chattered gaily something about Ben's sixth birthday. Ben did not respond to
this but continued wiggling and trying to crawl.
At this point, Ben had moved some six or seven inches. Then Mr. T. looked
over and said somewhat insistently, "Come on, Ben. Crawl." Ben did not look
at Mr. T. but he half-said and half-cried, "I can't do it." But Ben continued
bouncing and wiggling. As he strained very hard, he screwed up his face and
his breathing was quite jerky. He shifted his weight from side to side and
jerked his hands around as he endeavored to crawl along the floor.
10' Ben made more noise of a whimpering kind, almost crying. He con-
tinued trying very hard, struggling with his movements. Ben bounced up and
down on the calves of his legs, apparently using the momentum of the bouncing
to inch himself forward. Ben whimpered again, and it sounded almost like
crying. He kept struggling, wiggling and bouncing, trying to inch along on the
floor, (Celestia walked up and down the Physical Therapy room, passing
324 Physical Disability — A Psychological Approach
quite close to Benjamin. Ben didn't look up and made no response to her at
aU.)
11 ' Mr. T. went over close to Benjamin. He reached down, moved Ben's
hands apart and said, "Now, get your hands apart. Keep pushing with your
legs. You'll go. Pull with your hands. Come on, pull." This was said in a
didactic way; it was business-like instruction given in a not very pleasant
way — a type of very demanding encouragement.
12' In response to Mr. T.'s urging, Ben intensified his efforts. He fussed
louder, making a crying noise. His face was very sober. Mr. T. put his hand
on Benjamin's back to be of some slight assistance although not very much.
Benjamin continued to try very hard. Mr. T. said rather critically, "Ben, you're
not working. You're just not working at all. Let's go. You're just getting lazier
and lazier." There was no warmth or friendliness in this comment; it was
straight criticism.
13' Ben put forth even more effort. He screwed up his face, bounced and
wiggled, apparently straining very hard. He managed to move forward a little.
Then Mr. T. said more pleasantly, "Now, you're making headway. Just keep
going." Without responding directly to Mr. T.'s comment, Benjamin con-
tinued his wiggling and bouncing. He managed to move another inch or so.
14' Mr. T., still standing right behind Ben with his hands on Ben's back,
said, "Come on, now. Quit fussing and work. Let's keep going." This was said
almost bitterly. Ben continued his vigorous bouncing. He made crying noises
and whimpered with the exertion. At this point Ben's noises and whimpering
came very near to crying, but still Ben did not open up and bawl unrestrainedly.
15' Perhaps in response to Ben's intensified whimpering Mr. T. stepped
around behind him and lifted some of the weight from Ben's legs by pulling up
the belt straps in Benjamin's jeans. This apparently helped considerably for
Benjamin's fussing and crying noises diminished sharply.
16' Ben continued his efforts to crawl, struggling along the floor. At this
point he had traveled three or four feet from the initial starting place.
Marilyn [an aide] walked past and said cheerfully, "How are you doing,
Benrod?" Benjamin made no response.
Then Mr. T. released his support and stepped away from Benjamin. He said
insistently, "Come on, Ben. Pull 'em up. Pull 'em up." Benjamin continued
bouncing although not as earnestly as he had been just before.
17' Mr. T. said, "That's the way. Come on, now. You're moving." This
was said somewhat hopefully but still demanding that Ben continue his efforts.
Ben looked up almost tearfully at Mr. T. and asked, "How far?" Mr. T.
responded as though somewhat surprised that Ben should ask such a question,
"How far? Just as far as you can go, that's how far." Then Ben mumbled
something else which I couldn't understand. He continued to bounce and
wiggle, trying to inch along the floor.
Miss O. came through from the Physical Therapy room on her way to the
kitchen. She looked down at Ben and said jokingly and good-naturedly, "Aw,
dry up and blow away." Ben made no response but continued wiggling and
pushing. Miss O. continued on her way without saying anything further.
Motivating Children in the Rehabilitation Program 325
18' As Benjamin wiggled and bounced, he continued making whimpering,
almost crying sounds.
Celestia, who was walking back and forth under Mr. T.'s supervision, called
to Ben pleasantly, "Ben, are you laughing or crying?" She repeated the same
question. Ben responded, "Laughing," but it was said as though he didn't
really believe it. Then Celestia rephed in a pleasant, joking way, "What are
you laughing at? Yourself?" Ben said, "Yes," as though he knew this weren't
really true but he had to put on a good front.
Ben continued bouncing and wiggling as he struggled along. He continued
making the very same sounds, however, which to me were clearly much more
like crying than laughing.
19' Mr. T., standing behind Benjamin, said, "Come on, Ben. Keep working.
You're laying down. Get your knees way up." This was said insistently, with
no pleasantness even attempted. Ben made no response but continued wiggling
and bouncing.
Miss O., returning from the kitchen, said pleasantly, "Come on. Come on.
You're not even moving." Then she walked into the Occupational Therapy
room and stopped in the doorway. She turned around and looked down at Ben
on the floor.
20' She said jokingly but with sincere affection, "Oh, look at the monkey.
Look at the monkey." Ben looked at Miss O. A brief smile flitted over his
face at the joking comment. He quickly resumed his sober expression and
continued his efforts.
At this point Ben had moved about six feet from the starting place. Mr. T.,
who still was standing just behind Benjamin, said pleasantly, "Can you see
yourself in the mirror?" Ben replied, "No," matter-of-factly. Mr. T. said, "Well
turn so that you can," in a businesslike way. The mirror was directly in front
of Benjamin at the north end of the room. It was about five feet away from
him.
21' Benjamin continued struggling. He made whimpering sounds as he
struggled along. Mr. T., still standing behind him, said insistently, "All right.
Let's go. Let's go. Keep moving." Ben continued bouncing and wiggUng as he
struggled along. He was roughly seven feet from his starting point. Mr. T.
turned away from Ben and walked toward the south end of the room where
Celestia was standing.
22' Apparently in response to Mr. T.'s leaving him, Ben began fussing a
little more. He made more and more noise until he was almost crying aloud.
He kept trying, however, bouncing on his haunches and pulUng with his hands.
The more he tried, the louder he fussed.
23' Ben kept fussing and wiggling. His efforts were in vain, however; he
had made no progress since Mr. T. went to the other end of the room. Ben
continued struggling.
24' He stopped, turned his head around and peered back at Mr. T. at the
opposite end of the room. (This was the first time since he started that Ben
apparently was not trying to crawl.) Mr. T., who was just standing quietly
with his arms folded, patted his foot on the floor with impatience, indicating
that Ben should get busy. Then Ben promptly turned around and began trying
326 Physical Disability — A Psychological Approach
again very hard. Again Ben whimpered very intensively, just on the verge of
crying.
25' Ben wiggled and bounced. He fussed loudly. Then he turned around
again and looked at Mr. T. Since Mr. T. left, Ben had managed only to turn
himself around so that instead of facing north he was almost facing east. But
still he continued wiggling.
At this point Miss O. stepped into the doorway of the Occupational Therapy
room and said teasingly but pleasantly, "Come on. Come over here and I'll
give you a bite. Come on." She was talking about an apple which she was
eating. Ben looked up at Miss O. and smiled momentarily. Then he resumed his
efforts.
26' Mr. T. said more pleasantly, "See how far you've gone Ben. Quit
fussing and go up to the mirror." The mirror was three to four feet away.
Benjamin made no response to Mr. T.'s insisting.
Miss O. did something with reference to the waste can which was right by
the door, and she laughed very hard at whatever she had done. Ben looked up
and joined momentarily in Miss O.'s hilarity. Miss O. commented gaily, "I
knew that would make him laugh." Then she sat down on the edge of the
trash can.
Ben resumed his wiggling and bouncing as he struggled to crawl.
27' Miss O. stepped around behind the mirror and playfully peeped out
around the other side, trying to boost Ben's spirits. Ben apparently made no
response but just continued his wiggling and bouncing.
Ben intensified his efforts. As he did so his whimpers became louder and
louder until they amounted to a virtual cry. From the south end of the room,
Mr. T. called in a very threatening, not-to-be-questioned tone of voice, "Ben,
do you want to go to the bathroom with me?" [This means a spanking.] Then
Mr. T. continued, "AH right then, settle down and get busy." Miss O. went
into the Occupational Therapy room.
28' Ben made no observable response to Mr. T.'s severe orders but con-
tinued with his whimpering, fussing and wiggling as he tried to crawl. Then
Ben looked up into the mirror and continued with his efforts. Celestia talked
glibly with Mr. T. about something that would take place on Saturday. Then
she cheerfully asked Ben if he could see his face in the mirror. Ben made no
response; he simply acted as though he hadn't heard Celestia's comment.
29' Ben looked over at me briefly with no meaning in his look. Still Ben
continued trying. He fussed and wiggled. Ben had moved not more than a foot
or a foot and a half since Mr. T. went to the other end of the room. (Otto
and Verne [children] passed through the Physical Therapy room on their way
into Occupational TTierapy. Ben apparently did not notice them.)
30" Mr. T. came to the north end of the room and moved the mirror out
of the way. Then Mr. T. pointed with his toe to a line on the floor and said
seriously, "All right, Ben, get up to this line and then I'll put you in your
chair. Let's go, now." This was said somewhat hopefully and with real promise
in his voice.
31' Ben tried with renewed effort, it seemed. He bounced, wiggled vigor-
Motivating Children in the Rehabilitation Program 327
ously and cried with a little restraint. (Ben was extremely involved in this and
his efforts had been continuous from the very beginning except for the one
point which I mentioned.) He continued now, wiggling, fussing, and crying as
he tried to reach the point which Mr. T. designated. With all the exertion Ben
began coughing a little. As he coughed he relaxed his efforts somewhat. The
line to which Mr. T. had pointed was about two feet away from Ben.
32' Miss S. [school teacher] stepped into the doorway between the Physical
Therapy room and the classroom and made a very bitter comment about a
little boy who insisted on acting like a baby, saying that she was so tired of it
she'd like to throw him in the lake. She was obviously talking about Benjamin.
Ben, however, made no response. I'm not even sure that he heard her. He
continued his wiggling and bouncing, trying to get to the line.
33' Miss O. and Hilda came slowly through, going from Occupational
Therapy into the classroom. As Miss O. neared Benjamin, she jumped over
him, put one foot on each side and came down very hard making quite a noise.
This she did in a very joking, good-natured way. Benjamin made no response to
this but kept trying earnestly to get to the line. (Miss O. went on into the
classroom.)
Ben had managed by this time to cover about half the distance.
34' He reached his hand out as far as he could, pointed to the line and
looked up questioningly at Mr. T. Mr. T., who was standing just on the other
side of the line, looked down and said, "No, no. Now cut that out. That's
fudging. You've got to get all the way up to the line. You've got to get your
arms across and get your knees almost up there, about halfway across." This
was said in a more kindly, explanatory way. Benjamin resumed his struggling,
wiggling and bouncing as he tried to reach the required goal. After just a little
more effort, Mr. T. said, "O.K.," with finality. Then Mr. T. went to the other
end of the room and brought Ben's chair back. Ben relaxed visibly and just
sat waiting quietly. Mr. T. rolled the chair up to Benjamin.
35' Mr. T. picked Benjamin up and set him down rather forcefully in his
chair. Then as Mr. T. began strapping Ben in his chair, he gave Ben a lecture
about what was going to happen tomorrow if Ben insisted on continuing with
his fussing and crying while he was in Physical Therapy. He told Ben that he
just wasn't going to have any more of this whimpering and fussing and that if
he came in tomorrow and started whimpering and fussing they would go to
the bathroom and Ben knew what would happen then. ("Going to the bath-
room" means a spanking.) He told Ben that he was just getting lazier and
lazier and he was going to have to snap out of it. Mr. T. was quite critical and
very serious. There was no attempt to be good-natured or to gloss over the
criticism. It was straightforward and almost bitter. Ben made no observable
response to this lecture. I'm sure, however, that he understood everything Mr.
T. said.
Then Mr. T., having finished strapping Ben in the chair, took hold of the
back of the chair and shoved Ben out of the room with haste and dispatch. He
rolled him quickly up the ramp and took him into the classroom where he left
hizB.
328 Physical Disability — A Psychological Approach
Lila Participafes In the Speech Class
Lila is an 8 /a -year-old child who has lived at a school for cerebral
palsied children for nine months. She has both the athetoid and spastic
type of palsy. In walking, she extends her arms for balance, but falls quite
frequently. Her speech is very difficult to understand. Ben, Jimmy, and
Newton are three other children in the speech class, Ben being our little
friend who had such a hard time in the physical therapy session. Miss B.
is the speech teacher. It is the first class in the morning:
r Lila watched with mild interest as Miss B. moved Ben's chair over so
that the three were sitting in a Une. Lila looked up as Jimmy, a new boy in
the speech class, came in bringing a chair and set it next to Ben's.
2' Lila watched Miss B. who asked if "we should take our blow first." Miss
B. was referring to the exercise of blowing toy horns. Lila smiled a little as if
she liked the idea. All the children seemed to.
Miss B. gave each of the children a toy horn, telling them to blow long and
hard. Lila routinely took the horn Miss B. offered her. Lila held her horn with
her right hand, which she supported with her left hand. She put the horn in
her mouth. She had a little difficulty getting the horn to her mouth because of
the mild athetoid movements of her head.
Lila looked at Miss B. who said, "That's a good one," to Ben, who was
blowing his horn rather loudly. Lila continued to blow her horn. She took the
horn out of her mouth to take a breath. She put it back in the mouth to blow
again. She watched Miss B. who went from one child to another, encouraging
them in a friendly way.
Miss B. seemed to be trying to impart more enthusiasm to the children. Miss
B. encouraged the children by displaying her own enthusiasm. She said to the
group, "Come on, let's blow real hard." As she talked she directed her atten-
tion first to one child, then another.
Lila still held her horn with both hands. She blew it for all she was worth.
She worked so hard at blowing her horn that when she took the horn out of
her mouth to take a deep breath, her feet came up off the floor. The activity of
trying to blow hard seemed to be such an all-over activity that when she gave
out with a blast as loud as she could, her feet came up off the floor again.
Miss B. indicated this activity was over by holding out her hands and asking
for the horns. Lila routinely handed her horn to Miss B.
4' Then Miss B. said, "Now we'll do blowing sounds." The sounds they
were using were "f" sounds. Miss B. said, "Good, Newton." Lila watched as
she complimented Newton on his blowing sound. Speaking with warm enthusi-
asm, Miss B. asked Lila, "Let's hear yours." Lila made an "f" sound vigorously.
Miss B. spontaneously complimented her on it but helped her to do it more
smoothly. She encouraged Lila to do it again. She said to Lila helpfully, "Let's
do it again and this dme do it all through your mouth." This time Miss B. held
Lila's nose for her to help show her how to make the sound all through her
Motivating Children in the Rehabilitation Program 329
mouth. Lila watched intently as Miss B. demonstrated and seemed to put her-
self wholly into this activity, trying to do it just the way Miss B. wanted it.
Lila watched intently as Miss B. asked Newton with friendly anticipation,
"What do we have when we go to a picnic?"
5' Miss B. asked Lila to give the answer to the question, "What do we have
when we go on a picnic?" and Lila said, "Fun." Miss B. said, "Fine," explo-
sively as if she were really happy with the sound Lila had made. Lila had done
a good job.
The teacher went down through the rest of the children, Ben and Jimmy,
with questions requiring "f" sound answers. Lila turned to watch as each of
the children performed. Ben was asked a question, "What is this?" as Miss B.
wrote a "4" on the blackboard. Lila watched intently and smiled at Miss B.
Then Lila turned to look at the blackboard where Miss B. was writing a letter,
"S". Miss B. asked Jimmy to make this sound. Jimmy made the sound.
6' Miss B. exclaimed, "Good." Lila smiled. Lila watched with quiet interest
as Miss B. indicated Ben and asked him what he had eaten his breakfast with.
Ben failed to put the "s" on "spoon" and said, "poon." Miss B. in a friendly
way seemed quite disappointed as she said Ben had done just what they were
talking about. He had left off the "s" sound and she asked him to say "spoon."
Ben did. Lila smiled as Ben got it correctly.
Lila cocked her head to the left, to watch Miss B. intently as she went back
to the blackboard.
7' Lila watched Miss B. who said, "What do we do with our eyes?" Lila
said, "See," and Miss B. said, "Fine, let's clap for Lila." Then all of the chil-
dren clapped and smiled. Lila smiled bashfully; apparently she enjoyed the
recognition she was getting for having said the word so well. Then Lila looked
over to me and smiled. I smiled back at her. It seemed that she was still
happy to have done such a good job with this word.
Lila turned back to look at Miss B. She rubbed her upper lip with her hand
just under her nose as if she were still a Uttle sleepy. In rubbing her upper lip,
she turned her hand over, bent it sharply at the wrist, and rubbed with the top
of her wrist.
8' Lila dropped her head to her chest. (It wasn't quite clear to me if Lila
had dropped her head to her chest because she was tired or if it was just an
uncontrolled athetoid movement.) She let her chin rest on her chest for just a
moment. Then she raised her head and puUed it clear back; that is, she rested
the back of her head on the back of her chair so that she was looking up at the
ceiling.
9' Lila pulled her head back up to look at Miss B. She watched as Miss
B. said, "Now, let's make our singing sounds." Lila pursed her lips; she seemed
to be doing this as thoroughly as she could, really intent upon her job. She
tried to make the sounds that were indicated. She stopped and looked up as
Miss B. said, "Whose name begins with an 'm' sound?" She made the sound
for "m," the "m-m-m" sound rather than saying the letter "m." Lila said
spontaneously, "Mattie." Lila watched Miss B. who asked next, "Whose name
begins with an "1" sound?"
10' Miss B. asked questioningly, "Does your name begin with an T sound?"
330 Physical Disability — A Psychological Approach
Lila shook her head negatively, saying, "No." Miss B. acted very surprised and
indicated to her that it did. Then Lila laughed as if she recognized her mistake.
Newton, who was sitting next to Lila, laughed, too, in a friendly way at Lila's
mistake.
QUESTIONS TOWARD IMPROVING MOTIVATION
These three records represent a range of "techniques," of attempts on
the part of the adult to motivate the child. Some of them bear promise of
sound learning; others seem to impede learning, and even to lead to wrong
learning. In discussing them we do so with the recognition that it is one
thing to display wisdom under conditions of relaxed and objective ap-
praisal and quite another thing when one is involved in the day-to-day
difficult and time-demanding therapy with a child.
The problem of motivation would be vastly simpler if desirable
activities were satisfying in themselves. The natural pleasure of a child
when he eats an ice cream cone, romps, solves a problem which he has
set up, is enough to ensure the "positive valence" of these activities. All
too frequently, however, as we well know, the task at hand is at best a
bother, at worst intolerably disagreeable, unless incentives are provided.
There is no fun, in and of itself, in wearing braces as did Wally, in
laboriously crawling as did Ben, in making "f" and "s" sounds as did Lila.
The number of incentives used to motivate intrinsically neutral or
negative tasks is endless: the adult may promise the child a penny, a
piece of candy, a toy; the adult may threaten to spank the child, scold him,
report his poor progress; the adult may pat the child on the head, tell him
how well he is doing, give him an A or a gold star; the adult may make a
game of it or ignore the child, etc. Let us examine this variety in the light
of the following key questions:
Can the Task Be Recast so That It Becomes Part of an Activity That the
Child Likes to Do Anyway?
This principle can be applied to the difference between body building
through calisthenics and athletic games, or between learning to play the
piano through exercises and musical pieces. It simply takes advantage of
the natural interest of the person. Its application is seen in the speech
therapy class with Lila in the teacher's use of toy horns in developing
blowing skills and her use of a question-and-answer game for drill on
particular sounds. In Ben's case, some effort was made to enliven the task
at hand by playful teasing and by reminding Ben of the mirror (20'),^ but
2 Time notations in parentheses refer to specific portions of the records.
Motivating Children in the Rehabilitation Program 331
no real embedding of the crawling within an enjoyable activity was
attempted. Wally did not have to do anything with his braces except wear
them; after his initial resistance the braces were forgotten for a long while
in the excitement of the outdoor play and in this way they became an
unobtrusive part of an activity that Wally enjoyed. Occupational therapists
have devised many activities based on the principle of embedding, as when
children become involved in unbuttoning exercises in anticipation of the
surprise picture hidden beneath the buttoned cloth. In physical therapy
there is the use of weighted doll buggies in developing the child's balance
in early walking. Here is an area that could well be explored further by
all therapists: How can skills in sitting, standing, crawling, walking,
eating, dressing, talking, and so on be developed by submerging the
necessary drill within a framework that makes a pleasurable activity of it?
Although the principle of embedding also applies to adult motivation, it
is far more vital in the case of children who have greater difficulty in
keeping before them the significance of hard, dull, and sometimes painful
exercises for ultimate goals that are often indefinitely far into the future.
The child is much more bound by the immediate situation, and he may
well be unimpressed by the promise that crawling for a half hour on the
floor will eventually help him to stand with crutches, or that wearing his
braces will some day enable him to walk.
The principle of embedding need not, of course, be applied at every
turn. Sometimes repetitive drill is a happy relief from fun and frolic. Also,
the experience of doing something just because it should be done is
valuable even though it is tedious, as long as the child realizes the signifi-
cance of the task and is not overburdened by it. The danger arises when
the latter two conditions are ignored. We doubt, for instance, that either
Wally or Ben had much notion as to why he had to carry through the
adult directives. It is certain, in any case, that the task for Ben involved
excessive strain. Furthermore certain kinds of drill may be necessary or
desirable simply because they accomplish far more than could be achieved
through a playful activity. Finally, there are other motivating factors that
also elicit the cooperation of children with respect to the job at hand,
factors that may be more easily applied in a particular instance. Some of
these are discussed below.
Is the Child's Overall Experience in the Rehabilitation Session One of
Success or Failure?
"Nothing succeeds like success" is a psychological truth of everyday
life. Experimental investigation has discovered at least three important
reasons for this. To begin with, success often enhances the attractiveness
of a task, whereas failure often acts contrariwise, turning an otherwise
332 Physical Disability — A Psychological Approach
acceptable task into a disagreeable one (Cartwright, 1942; Gebhard,
1948). Comparable effects hold for anticipated success and anticipated
failure. Secondly, success normally increases the level of aspiration — i.e.,
the goal one sets for oneself with respect to the task — whereas failure
tends to decrease it (Lewin et al., 1944). Finally, it has been shown that
persons with a background of success in the particular area of concern
differ significantly from those with a background of failure, with respect
to how realistic their goal-setting is. The academically successful children
in Sears' study (1940), for example, expected improvement well in line
with their current performance whereas those with a background of failure
tended either to expect no improvement at all or to expect completely
unrealizable gains.
Whether or not success has occurred can be indicated to the person
primarily in two ways. First, there is the performance as such. In the
usual level-of-aspiration experiments, as well as in many situations of
everyday life, the person can readily tell whether he has achieved his
goal or not. If his goal is eight bull's-eye hits out of ten, for example, a
score of two or nine speaks for itself. There are many situations in real
life, however, when success is indicated not so much by the performance
itself as by how that performance is judged by others. Social evaluation,
then, becomes a second indicator of success. When the goal itself is not
too clear, or when the performance is not easily ranked with respect to
the goal, then praise and reproof become, for the person, the main signs
as to how well he is doing. Lila, for instance, knew that she was improving
her "f" sound not as a result of the raw data presented by the sound itself
but by the complimentary remarks of her teacher (4').
Whatever the indicator, however, the experience of success and failure
is a psychological experience, the essence of which is either satisfaction
and pride in accomplishment or dissatisfaction and, more extremely,
blame on the self for the failure. As a psychological experience, the feel-
ing of success usually requires that the person achieve by his own efforts
goals important to him and near the top of his ability level. If he is
engaged in tasks that are very easy for him, or if the task itself is re-
pugnant to him, or if it is accomplished largely through the efforts of
others, then any success is likely to be a peripheral experience, lacking
the pride in accomplishment that provides the strongest bolster to one's
ego and encouragement to go on. This means that the child's abilities
need careful assessment so that realistic goals requiring some effort on his
part can be established. It means that the goals themselves must become
sufficiently important to the child, so that he upholds and strives toward
them.
Some words of caution are in order. First, although the task must
assume some importance for the child if success is to be experienced, one
Motivating Children in the Rehabilitation Program 333
must be careful lest it become too heavily invested with a do-or-die
significance. Praise, if overdone, can bring about just this kind of emo-
tional intensification. It can also make the child too heavily dependent on
flattery and commendation, too sensitive to possible failure, too much
concerned about his status rather than about the task as such.
Secondly, not every occasion must be designed so as to elicit a success
experience. As the work of Barker and H. Wright showed (1955), most
of our waking hours by far are neutral with respect to success and failure
(see pp. 90-91). Likewise, in rehabilitation programs, the stimulation
of success can become an overstimulation if the person is geared to it in
every activity he undertakes. One needs the temperance afforded by
activities that are indifferent to success and failure, though it still remains
true that the overall program should be marked by well-paced success
experiences.
That success is a potent motivating factor, leading to heightened goals
and making the task at hand more pleasant, is not to be taken lightly, and
yet the motivator often neglects to take this factor into account. Sometimes
it even seems that he is determined to ensure repeated failure. Let us see
how the principle of well-paced success fared in the experiences of Wally,
Ben, and Lila. The analysis will concern both the relation between per-
formance and goal as an indicator of success and the reaction of the
adults as social evaluators.
Wally may not have experienced failure, but he certainly did not feel
any pride in accomplishment, the main criterion of a success experience.
Moreover, the situation did not provide any of the indicators that could
reveal to him that he was succeeding in anything worth-while. Not once
did his mother praise him during the hour and a half that he wore his
braces. If anything, her acknowledgment that she did not like the braces
either (7') provided social confirmation that the whole affair was dis-
agreeable and to be avoided. As for Wally's performance as an indicator
of achievement, the necessary goal structure was lacking. Moreover, the
vague goal as imposed by his mother — to wear the braces until he had
breakfast and played a while (6') — became vaguer still because he
doubted her intentions. His mistrust evidently had some basis, for an hour
and 15 minutes later he was still wearing them, and it took three imperi-
ous reminders on Wally's part before his mother removed them. A vague
and unacceptable goal, with no encouragement along the way, provides
little support for striving.
To be sure, Wally was generally in an uncooperative mood (some of
the reasons for which are suggested in the following sections) and at the
time nothing might have worked, but certain suggestions do come to mind
as to what Wally's mother could have tried. She could have commented,
after putting on his braces, that now he was standing nicely (6'), for
334 Physical Disability — A Psychological Approach
without them he could do nothing but slump. At least this would have
reminded him that he was accomplishing something worth-while. She
could have counted the seconds that he could stand alone, or the steps
that he could walk holding on with one hand or unaided, as well as kept
a record of his progress. At least this would have established a concrete
and reahstic standard, a goal that gave meaning to his performance here
and now.
The importance of establishing well-structured goals that are attainable
within a relatively short time and are guided by past performance warrants
further comment. One difficulty is that we are often unable to establish
long-term goals because we do not know them. We cannot say with
assurance, for example, that this three-year-old child with cerebral palsy
who is just beginning to learn to sit tailor fashion will eventually be able
to walk, with or without crutches. Fortunately, long-term goals are not
necessarily the most desirable from the point of view of the immediate
task at hand or of motivating potential. Doubtless, it might be most
helpful for purposes of educational planning to know whether a child will
remain bedridden or be able to get about in a wheelchair, but for getting
him to sit alone this need not play a role. Actually, immediate goals may
more fruitfully be established in terms of recent performance rather than
future, hoped-for accomplishment, for one's gains become successes. In
the following account, a young woman in the rehabilitative phases of polio
recalls:
. . . "Come now," the therapist would lie beautifully, "you stood for twenty
seconds longer yesterday," and I almost collapsed as I remembered standing for
almost three hours talking to a boy who had carried my books home for me
from high school. Twenty seconds! I felt as though I had been there twenty
years! But in this manner my therapist increased my standing time, my
confidence, and my strength. And I seriously realized that unless I tried harder,
tomorrow would be no different from today, and I tried to do just a httle
better than I was asked to do [Linduska, 1947, p. 11 6].^
In Ben's case, unmitigated failure pervaded almost the entire session,
being capitalized at the end by undisguised chastisement and threats of
punishment. Also the goal was apparently both unclear and unattainable
for Ben.
Perhaps the therapeutic procedures from day to day were so similar
that the therapist did not see the need to orient Ben explicitly toward the
goal. If so, one of course would call this into question, since it would seem
desirable to establish and make clear each day just what the objectives are
3 Noreen Linduska, My Polio Past, copyright 1947 by Noreen Linduska.
Used by permission of the publishers. Farrar, Straus and Cudahy, Inc.
Motivating Children in the Rehabilitation Program 335
and, equally important, something of the why of them. The therapist did
ask during the third minute, "How far are you going to crawl today?" but
the interaction was so brief that it could hardly have been a serious
exploration of the task ahead. And though in the fifth minute the goal,
crawling about 10 feet, was mentioned, 12 minutes later Ben whimperingly
asked, "How far?" The therapist missed this excellent opportunity to
clarify the situation, and instead made the goal uncertain and hopelessly
out of reach by replying, "How far? Just as far as you can go, that's how
far."
Early in the lesson Ben was convinced that the goal, whatever it was,
was beyond his capabilities. If Ben had been soundly motivated, crawling
10 feet might have been well within his capability. But as it was, after
about four minutes of trying to crawl, Ben was very discouraged, saying,
"I can't do it." (9') The therapist, busy with another child, ignored Ben
until two minutes later, when he did instruct Ben on just how to crawl:
"Now, get your hands apart. Keep pushing with your legs. You'll go. Pull
with your hands. Come on, pull" (11'). But this businesslike instruction,
demanding and unsympathetic, hardly served to convince Ben that he
really could accomplish the task if he tried. The therapist could have
pointed out that Ben already had crawled seven inches, that yesterday he
did such and such. The goal could also have been structured anew and
even modified to make it more in line with what Ben could accomplish.
This point has frequent application in teaching situations: When a task
appears to be too overwhelming, breaking it down into subgoals can make
it seem far more manageable. Suppose that Ben's therapist was convinced
that Ben could and ought to crawl 10 feet that day. But observing that
this appeared to be a Herculean task for Ben, Mr. T. should have altered
the situation. The first lap of the journey across the floor could be set at
five feet or two feet if necessary. These substations could even be dif-
ferent towns or stores on the way to the circus, the ultimate goal 10 feet
away. Appropriate rewards, all in the spirit of the play, could provide
further incentive at each of the subgoals. The task as recast has been
turned into a game consisting of parts that should be felt as attainable
by the child with reasonable expenditure of time and energy. It must be
remembered that Ben was just 6 years old, and surely for so young a child
immediate goals should be within reach in less than the 30 minutes during
which Ben labored.
As it was, Ben strained and whimpered, almost as if he wished to prove
that the task was in fact beyond him. It is noteworthy that 20 minutes
after Ben started to crawl, he was not even facing the mirror, though at
that time he was about four feet from it (25') .
One suspects that the interpersonal relations between Ben and his thera-
pist led to a turn-about-face in Ben's motivation, so that instead of
336 Physical Disability — A Psychological Approach
wanting to reach the goal, however vague, he wanted not to reach it.
Certainly for Ben crawling was a difficult job, but apparently he made
more ado about it than was warranted. This annoyed the therapist, who
did not realize that by it Ben was trying to say, "See how I am trying.
See how miserable I am. Give me credit for my straining and pain."
Throughout the session Ben was chastised so that even if he had finally
reached the goal, there would have been but small joy in its achievement.
Toward the end of the session (30') the goal was lowered but certainly
not in a way that would give Ben a feeling that he had done an adequate
job. Four minutes later (34'), when Ben had virtually reached the new
goal by stretching out his hand, he was in effect slapped down for
"fudging." Finally, at the end of the session (35'), Ben was reprimanded
and threatened in no uncertain terms. He was told that his performance
was fussing, crying, whimpering, lazy. One can hardly imagine greater
defeat, for not only did he fail the goal of the therapist, but Ben's own
goal of proving his effort was totally unrealized. The change in Ben's
mood, which was quite cheerful at the outset, is striking. The session is
an excellent example of the effects of persistent failure: the goal is
lowered; the task becomes more disagreeable.
Lila's experience was very different from that of either Wally or Ben.
She started out being pleased (as was Ben, but not Wally) and ended
being pleased (as neither of the boys was). Satisfaction with her per-
formance, even when she was given help in bettering it, pervaded the
session. The feeling of success primarily grew out of the teacher's
encouragement and praise of the children's efforts and accomplishments.
Satisfaction spread to the group as a whole so that success was further
underscored by the smiling and hand-clapping of peers. Notice that when
Lila was corrected it was in a positive, noncritical, certainly nondis-
paraging way (4', 10'). Furthermore, the goals were sufficiently immediate
and clear for the children to appreciate what it was they were trying to
do. To blow a horn, make certain sounds, answer certain questions, pro-
vided definite guides for their efforts. Though success was heavily deter-
mined by the teacher's evaluation, it was not bandied about irrespective
of the child's efforts and performance.
In none of the records did the children have much to do with determin-
ing their goals. It is not proposed here that the child must always be "the
architect in his own betterment" but participating actively in the setting
up of goals not only provides needed experience in this important area but
also is an excellent means for eliciting the child's cooperation. Active
participation and enthusiasm are not unrelated. Helping to determine a
goal is one of the best ways for the person to become motivated to achieve
it. One could imagine that even Wally, who wanted to have nothing to
do with the braces, could have been maneuvered into specifying how
Motivating Children In the Rehabilitation Progrann 337
many counts he could stand alone while wearing them. Certainly Ben
would have been eager to help decide how far he could try to crawl that
day.
If the children make their task too easy, or too diflBcult, in time their
judgment can be expected to become more in keeping with their real
ability since success and failure usually act as a sound gauge for the level
of aspiration. Besides, the guidance of the adult in these matters is
certainly not precluded. The level of aspiration is usually set near the top
of the person's ability when the person has been free to raise and lower it
in accordance with his experience of success and failure. Of course the
sensitive teacher also raises and lowers the child's goals in accordance with
this evidence. In any case, sound goals insure an adequate amount of
success, which in turn acts as a stimulant to motivation and leads to the
establishment of new challenging goals.
Unfortunately the interaction of success, failure, and the level of
aspiration does not always act as such a happy regulator of optimum
experience (Barker and Wright, 1952:19).
1. If aspirations are placed well below the level of a person's highest ability,
he will not experience success. He wiU, in effect, be a deprived, frustrated
person because his central needs for self-esteem and social appreciation are
not satisfied. This may occur when the person, for complex reasons, is afraid to
risk even momentary failure, or when rigid goals are superimposed from the
outside.
2. Dissatisfaction is also the lot of the person who, though placing his goals
sufficiently high, does not attain them by his own efforts. We have all known
children, and adults too, who have been given "everything" yet who are
supremely unhappy and often insatiable in their demands for more things, more
attention, more experiences.
3. Finally, there are those who consistently place their aspirations above
their ability to achieve. They are then regularly confronted with failure and
deprived of self-esteem and social satisfaction. In the case of disability, this
frequently occurs when "normal" physique and ability become the idolized
standard so that the goals he sets for rehabilitation remain far out of line
with even the best that can be reahsticaUy hoped for.
In each of these three situations, something is interfering with the
feedback between success and failure on the one hand and the level of
aspiration on the other. Sometimes the disruption is due to the imposition
of rigid and unrealistic goals from the outside. Sometimes the anxieties of
the person himself prevent him from raising and lowering his goals in
accordance with the realistic evidence of success and failure. Since goal
behavior is not an incidental aspect of a person's adjustment but deter-
338 Physical Disability — A Psychological Approach
mines much of the person's overall feelings of satisfaction and failure, it
is well for the adult to keep on the alert for opportunities in the rehabilita-
tion situation where the child can feasibly be drawn into this important
process.
To sum up, the following can be asked in evaluating whether well-paced
success characterizes the child's experience:
Is the goal within the child's reach?
Is it flexibly gauged in terms of actual performance?
Has the child had a part in establishing it?
Are subgoals necessary to encourage striving?
Has praise been given to indicate success?
Has praise had the balance of matter-of-fact and task oriented ap-
praisal?
Is the child able to determine accomplishment in terms of the per-
formance itself?
Are there sufficient interludes where success and failure are not at stake
and the activity carries itself, either because it is accepted as a job to be
done or because it is enjoyable?
Success as presented here may seem overemphasized. Some may argue
that particularly in the American culture the success story is already
excessively highlighted. The issue here, however, does not identify success
with unusually high standards but rather with individually reachable ones.
Moreover, as Hilgard and Russell {1950) point out, the child does not
have to be taught to accept failure by providing him with repeated failure
experiences. "A better preparation for failure is to have a sufficient back-
log of success experiences so that failure is not devastating" (p. 52). They
remind us that it is possible to teach toleration of failure, as shown in the
study by Keister (1937), by drawing upon success, not failure, as the
regulator of conduct. In that study the chUdren were taught to accept
failure by linking temporary failure with ultimate success. They were
taught not to be impatient but to keep striving until success was achieved.
When failure indicates "how to do what better," it can stimulate learning,
but certainly the children in the Keister study were not taught to endure
lasting failure.
This point fits in well with one of the main themes of this book —
namely, that maintaining the standard of the nondisabled as the guide
and evaluator of the behavior of the person with a disability has the
probable outcome of relegating him to a life of failure, the acceptance of
which is equivalent to resignation. On the other hand, according to the
theoretical position held in this volume, acceptance of a disability requires
basic changes in values so that new and reachable goals become meaning-
ful.
Motivating Children in the Rehabilitation Program 339
Is There a Place for Extraneous Incentives?
The attractiveness of an activity and the satisfaction of goal achieve-
ment provide what may be considered to be intrinsic incentives. There are
other sources of motivation, however, that are external to the activity
itself. These are commonly referred to as rewards and punishments.
Experimental investigation supports the common belief that rewards
and punishments can serve as powerful motivators of learning. They can
do so in at least two ways. First, they can provide important information
to the person as to what constitutes incorrect and correct responses. If
the subject is reprimanded (or, as is the modus operandi with experi-
mental animals, shocked with an electric current) every time he makes a
wrong move, and praised (or fed a pellet) every time he makes the right
response, then he may be able to correct his behavior and learn accord-
ingly. If a child is excluded from the game because of misbehavior, he
may become impressed by the necessity of abiding by the rules on the
next occasion. Secondly, rewards and punishments can serve to mobilize
the person's energy and attention toward the learning task. In a well-
known experiment by Hurlock (1925), for example, it was shown that
school arithmetic improved most when the children were praised, next
when they were reproved, and least when they were ignored. Because the
praise and reproof were administered to the children as a group, no in-
formation was gained as to specific errors and correct responses.
Although punishment can stimulate learning, psychologists are generally
agreed that, unless it is carefully considered, it is easily misused. In the
words of Hilgard and Russell (1950), "The interpersonal aspects of the
punishment situation are fraught with more hazards than those in reward.
As a teacher or parent becomes emotionally upset, it is an easy matter to
take out aggression on children through punishment. The children may be
provocative, but the danger of injustice in punishment is great, and chil-
dren are extremely sensitive to injustice. The meaning to the child of
being punished by a powerful adult is complex, and regardless of the
effect on immediate behavior there may arise concealed attitudes of resent-
ment, of dislike of the work for which punishment was imposed as well as
of the punishing teacher" (p. 49).
What Else Is the Child Learning?
One of the most important questions we can ask in evaluating incentives
is: What else is the child learning? In the case of intrinsic incentives, the
verdict is positive, for to know the pleasure of an enjoyable activity and
the satisfaction of goal achievement leads to a feeling of well-being and
340 Physical Disability — A Psychological Approach
enhances striving still further. But in the case of extrinsic incentives, the
end result is not as pure.
If castigation predominates in the person's life, his self-concept is in
danger of becoming an abject apology. In just the single session, Ben
heard (and learned?) that he was lazy, fudging, a cry-baby, and in fact
a total failure. More than that, he was learning that effort did not count
for much (he had really worked hard for more than half an hour); it
was achievement, and an unattainable one, that mattered. He also learned
to dread the next session.
Even so-called playful teasing on the part of the adult may easily be
misconstrued by the child. When Miss O. jokingly said to Ben, "Oh, look
at the monkey. Look at the monkey" (20'), was this a delightful jest to
him? When Wally's mother agreed with him in disliking his braces and
that they would be tossed in the river at the first opportunity (7'), was this
taken merely as sympathetic understanding? Or did this interplay also rein-
force Wally's emphasis on the succumbing aspects of his disability — that
the braces signified pain and trouble and his inability to walk — rather than
the aspect of coping?
As for rewards, one can well ask whether the child is learning to rely
on adult adulation or bribes in one form or another as a necessary
accompaniment to striving. When used judiciously, however, the child
may not only become motivated, but also may learn that effort, coopera-
tion, progress, etc. are indeed important.
In Chapter 5, in the discussion of acceptance, it was pointed out that
one of the helpful value changes is that of subordinating physique. At the
same time, the very purpose of rehabilitation — to improve physique —
serves to emphasize it. This contradiction makes it even more necessary
to free the rehabilitation setting of emotionalism, which makes physical
achievement all-important, a goal upon which one's destiny rests.
These examples are sufficient to bring out that in the rehabilitation
situation the child learns far more than the immediate task at hand. He
learns about himself and others, what is valued and what is not, basic
attitudes that become an influential part of his orientation to life in
general and to his disability in particular. By questioning what else the
child is learning, one is often able to spotlight the strengths and weakness
of one's methods.
Are Background Factors (Time, Place, and Social Conditions) Optimal
for Learning?
Especially because all of us hold preconceived notions as to the back-
ground conditions most conducive to learning, these must be consciously
checked by the evidence presented in actual practice. The following is a
Motivating Children in the Rehabilitation Program 34!
good example of how a parent's reasonable notions turned out not to fit
the facts:
During this summer, I experimented with giving Karen her physiotherapy on
the beach. It didn't work.
I found that the cold water increased her spasticity, making already stiff
muscles that much stiffer (temporarily). I found that more than twenty minutes
of sun had much the same (temporary) effect.
I then tried doing her therapy immediately after her nap and so learned
something interesting, and today still inexplicable. Instead of being relaxed
and "soft" immediately after sleep, as one might reasonably expect, our
daughter is more spastic and it is necessary to allow one full hour to elapse
from the time of waking to the start of any therapy [Killilea, 1952, p. 149].*
To question the background conditions of the case at hand is also
necessary because individual differences in diurnal rhythms pertaining to
alertness, moods, and energy are great. Wally's general mood, as the scene
opened at eight o'clock in the morning, was resistant and fretful. Although
this could be attributed to the possibility that he was reacting to the
prospect of his hated braces, it is to be observed that he became cheerful
during breakfast. One wonders if Wally needed time to wake up after
rising, if he is not generally disgruntled until breakfast sets him right with
the world. If this is the case, one would certainly recommend postponing
bracing until then.
The factor of social facilitation, as we well know, can have a tremen-
dous impact on the person's readiness to undertake a task. Lila's thera-
peutic situation made the most of this background condition. There, other
children were doing the things she was asked to do. They were praised
and she was praised. They were pleased with her success and she was
pleased with theirs. Ben, on the other hand, had to become involved in a
task very much apart from any supporting group. To be sure there were
people around, but they were engaged primarily in other pursuits, their
contact with Ben being more or less capricious and sometimes only adding
to his misery. His therapist was also preoccupied with working with
another child. In fact, he remained with Ben for only one minute after
he placed Ben on the floor (4'). Intermittently he did direct Ben from
afar, but without the necessary positive emotional involvement for
generating a genuine "we feeling." Several minutes later the therapist
rejoined Ben and remained with him for about 10 minutes (H'-Zl'). It
is to be observed that when the therapist left again, Ben's fussing increased
as though he were fairly crying out for someone to be "together with"
him in his ordeal. During the next eight minutes the therapist was across
* Reprinted with permission of Prentice-Hall, Inc., from Karen by Marie
KiUilea. Copyright 1952 by Marie Lyons Killilea.
342 Physical Disability — A Psychological Approach
the room and Ben made little progress (22-30'). In spite of the steady
stream of people in and out of his orbit, Ben apparently felt very much
alone.
Not always, of course, does a child need the stimulation of other chil-
dren. And it is not always easy to provide that stimulation. Wally was
not in an institutional setting where there were other children who needed
similar treatment. In such circumstances, the child may resist the therapy
just because none of his playmates has to be bothered with it. It sets him
apart, makes him feel different and lonely. Being aware of this, the parent
may be able to draw the child's friends into certain phases of the rehabili-
tation program. An older child could keep score as Wally stands alone
and all could rejoice in his progress. Karen's mother called the neighbors
in to watch Karen for the first time as she walked with her new crutches
(Killilea, i952;217-219). The important point is that care should be
taken to keep the child from feeling that no other children have any
interest in the rehabilitation task before him.
What Are Some of the Basic Attitudes That the Child Has Toward His
Disability and the Rehabilitation Procedures That Surround It?
A child's readiness to participate in the rehabilitation program depends
not only on specific conditions surrounding the task that promote en-
thusiasm or not but also on the whole personality of the child, on his
general attitudes toward himself and the disability. Why did Wally hate
his braces so? It may have been because the situation was poorly con-
structed from the point of view of specific motivating factors, but it may
also have been because the braces represented for Wally "nothing but
trouble." They may point to the succumbing aspects to the exclusion of
their significance for coping with the problems imposed by the disability.
In Ben's case, the predominant attitude was "I can't." Again, this may
have been a consequence of the unfortunate way in which the task was
planned but it also may reflect Ben's pervasive feeling about himself — that
he is helpless, pitiable, and unable.
In other words, the child comes into the situation with important needs
and attitudes that will affect his reaction to it. Needless to say, what
happens in the rehabilitation setting can influence for better or worse the
child's attitudes toward himself and his disability.
Sometimes our best efforts to motivate a child fail just because we
remain unaware of what the total situation means to him. Although such
awareness often requires a sensitive orientation to the child, it is surprising
how often we overlook even the most direct cues. Neither Wally nor Ben
was asked why he felt as he did. What might Wally have said? What
might Ben have said? We need not necessarily probe for unconscious moti-
Motivating Children in the Rehabilitation Program 343
vation. Our handling of manifest attitudes can also lead to sympathetic
understanding of underlying feelings. Even a superficial rationalization on
the child's part needs to be taken into account. A child's ability to con-
tribute knowledge and understanding to his situation must always be
respected. This may be an obvious truth, but it is all too often violated just
because of the devaluated status of children.
Does the Motivator Feel Friendly to the Child and the Task at Hand?
Human motivators are human beings and as such they, too, come into
the situation with needs and attitudes toward the child and his disability
that profoundly influence the proceedings. The enthusiasm and friendly
encouragement contributed by Lila's therapist to the situation is clearly
not something divorceable from her personality and warmth toward her
pupils. On the other hand, if the adult dislikes the child, easily becomes
angered and impatient, is discouraged about the rehabilitation possibilities,
or is basically uninterested, then no matter how many motivating devices
are introduced, they caimot be fired with the necessary spark for effective
and sound learning. Perhaps the most important question of all concerns
the adult's underlying feelings toward the child and toward disability.
Aside from these additional factors determining so much of the adult's
performance in the rehabilitation situation, there is the practical problem
of repetitive therapy. The question concerns motivating the motivator:
How can therapy that must be carried out day in and day out continue to
be of sufficient interest and challenge to the therapist so that he enters at
least most of the sessions with that enthusiasm necessary to encourage
and motivate his charges? This problem, of course, applies to all teachers,
including parents. Part of the answer lies in the selection of personnel,
and part in the arrangements of the working situation.
We know that in teaching institutions, rehabilitation workers see added
challenge in the daily routines because what they are doing is shared with
students in training and other members of the staff. There is something
new in everyday events when they are analyzed and thought about, when
they have to be justified and evaluated. Other instances of the kind of
social involvement that tends to keep alive one's work and interest result
when visitors frequent therapy sessions and when the rehabilitation
worker participates in planning and evaluating the rehabilitation program.
One must add, of course, that heavy case loads, long hours, and insuf-
ficient respect for the functions of the rehabilitation worker are unfavora^
ble conditions for the kind of keen awareness we are seeking. :
Parents seldom have sufficient opportunity for that sharing with other
adults which does so much to strengthen understanding and determination
to persevere in spite of boredom and difficulties. Parent discussion groups
344 Physical Disability — A Psychological Approach
and more frequent contacts with visiting nurses and other therapists are
indicated. Of course, the genuine motivation of most parents for whom
the welfare of their children is uppermost will carry them a long way.
Little has been said in the foregoing discussion of motivation that has
not been said before or that is difficult to grasp. But because the key
questions often find little reflection in actual practice, they need to be
raised again and again as checks that highlight the psychological signifi-
cance of the learning situation.
One might wonder why "theory" and "practice" are frequently far
apart. Perhaps it is because the questions raised here are obvious only
after they have been raised and because the principles that provide some
of the answers are not such truisms as one might think. After all, though
the motivators in the three rehabilitation records which provided our
"living" material tried to be on their best behavior, being under observa-
tion as they were, they were nevertheless unable to avoid glaring errors.
Sometimes, of course, one's best intentions become deflected by con-
flicting feelings. Wisdom helps, but only succeeds when it is sustained by
feelings that support it.
14
Chapter
The Client as Comanager in
His Rehabilitation
The effectiveness of rehabilitation, whether it involves physical,
vocational, or emotional adjustment, depends largely upon the degree to
which the client has made the plan his own. Barring special circumstances,
this support on the part of the client in the long run is enhanced when
he takes an active part in decision-making; it is often weakened when he
feels that his life is being manipulated behind the scenes, even when it is
by the experts who know best "where he is to go and how he is to get
there."
Few counselors would deny the importance of active participation on
the part of the client. But it should be emphasized that active participa-
tion as it is used here is not, as is often assumed in practice, synonymous
with "cooperative attitude." Of course it is pleasing to the counselor to
find that the client willingly submits to all manner of test procedures, that
he responds to questions fully and with enthusiasm, and above all that he
follows the counselor's recommendations. This is the "good" client. But
this is not the active participant.
The specifications of active participation become clarified when the
client is thought of as part of management. Then it is that he not only
answers questions but raises them; that he not only contributes data to his
case but helps evaluate them and works through to their solution; and
finally that he claims the veto power as well as voting privileges (except
in special circumstances; see pp. 357-358). The "principle of comanage-
ment" is an apt designation for the kind of relationship advocated. It
connotes active participation by both client and specialist. This principle,
or even philosophy, also underlies a good deal of the discussion of the
parent as a key participant and of motivation in the rehabilitation situa-
tion (Chaps. 12 and 13).
345
346 Physical Disability — A Psychological Approach
BASIS FOR ENCOURAGING COMANAGEMENT
ON THE PART OF THE CLIENT
The reasons why the adult in particular and the child as he grows older
should participate in the management of his rehabilitation are important.
The first of these concerns the matter of self-esteem.
. . . the worker-client relationship tends to be an asymmetrical one in
which the professional person has the higher status position. Just as in the case
of doctor and patient, lawyer and client, or teacher and pupil the disabled
person may easily feel [himself to be] in a dependent position in which it is
hoped that the wisdom of the worker will guide him through his difficulties.
But it is just such an atmosphere of a wise and powerful one, on the one hand,
and a dependent, suppliant one on the other hand, that so easily can nourish
the feelings of inadequacy and personal inferiority that true rehabilitation seeks
to avoid. The inner strength and self-respect which we wish to build in the
client grows in a relationship in which the disabled person feels that he has
an important role in planning his life and that what he says and what he feels
is respected. . . . Even a disabled child needs to have a feeling that he knows
what is happening to him and why, that he has a choice in the decisions. How
much more true this is of the person who has reached adulthood with all the
independence of judgment and self-determination that this imphes [Barker and
Wright, 7952;2{>-21].i
To repeat: Inner strength and self-respect grow in a relationship in
which the person feels that he has an important role in planning his life
and that what he says and what he feels are regarded as important.
Motivation to make the plan work is the second important reason for
stressing the participation of the adult in the evolving as well as the
executing of the rehabilitation program. As one pamphlet addressed to
patients put it: ". . . the final result depends on you and how much you
put into it. Their [staff] job is important, but yours is more important"
(Rusk and Taylor, 1946:85).'^ When the client feels that he had little to
do with the plan in the first place, it is all too easy for him to dissipate
his energies in minor complaints. He is less apt to be ready to make
personal adjustments as required by new and sometimes disagreeable
circumstances than when he has been a participant in mapping out the
1 R. G. Barker and B. A. Wright, The social psychology of adjustment to
physical disability, in J. F. Garrett (Ed.), Psychological aspects of physical
disability, Department of Health, Education, and Welfare, Rehabilitation Serv-
ice Series, No. 210.
2 H. A. Rusk and E. J. Taylor, New hope for the handicapped, Harper &
Brothers, 1946. By permission.
The Client as Comanager in His Rehabilitation 347
rehabilitation course. How often does a person, presumably vocationally
rehabilitated, leave the job after six months as a result of relatively un-
important sources of irritation just because, not having had a crucial say
in the vocational alternatives, he has readily placed in the counselor's lap
the responsibility of getting him the perfect but nonexistent job! Experi-
ence with psychotherapy has well established the proposition that suc-
cessful outcome is generally favored when the patient assumes some
responsibility during the planning phase of his rehabilitation. Patient
responsibility forms the cornerstone of what is known as "nondirective"
therapy (Rogers, 1951) and is certainly an essential building block of the
more directive types of psychotherapy (Fromm-Reichmann and Moreno,
1956).
A third consideration is the fact that our fund of knowledge is often not
sufficiently exact to enable the counselor to know which course of action
is best for the client. On these grounds alone it would seem desirable to
allow for the views and intentions of the client.
As a concrete illustration of this point, let us examine the controversial
issue as to whether people of good intelligence should be provided higher
education irrespective of the degree of physical disability. Cruickshank
(1955) has spoken out strongly in the negative, arguing that "the 'over-
trained' physically handicapped person is one of the real tragedies of our
time" and that such persons "will be happier if adjusted in a less skilled
job than when they are frustrated in an attempt to adjust and compete
in professional fields where the possibility of real achievement is seriously
limited if not impossible" (p. 360) .^ In support of his argument, he
presents the following case:
A quadriplegic athetoid young woman graduated in psychology from a
college, summa cum laude. She was admitted to a graduate school of another
university for her master's degree which she completed in the upper tenth of
a class of 225 students. Parental requests were made to the university to con-
tinue the girl on to the doctorate, which on the basis of innate ability could
easily have been achieved. The girl was hopelessly handicapped and crippled.
Her speech was more than poor. She needed a companion to assist her in all
basic self-help skills. She could not independently walk. Her accomplishments,
great as they were, were laboriously achieved through the use of an electric
typewriter. Permission was denied for further graduate study in clinical
psychology where her opportunity for employment was seen to be nil. A cur-
rently unhappy person with more unusable professional training than she ever
should have been permitted, this girl should initially have been admitted — at
3 W. M. Cruickshank, Educational planning for the cerebral palsied, in W. M.
Cruickshank and G. M. Raus (Eds.), Cerebral palsy: its individual and com-
munity problems, Syracuse University Press, 1955. By permission.
348 Physical Disability — A Psychological Approach
most — to a culturally oriented liberal arts program geared primarily to self-
enrichment and no more. Inadequate guidance failed this student and her
parents [pp. 360-361].
Although this point of view cannot be ignored, the following issue is
crucial to its final evaluation: Isn't a judgment of employability at best an
estimate of probability and isn't an unwarranted wisdom assumed on the
part of even the most expert vocational counselor when he feels able to
say with assurance that a particular individual will be unable to put his
training to productive use? The remarks of Lowenfeld {1956) with re-
spect to the vocational pursuits of blind persons have wide generality. He
reminds us that any list of occupations must remain incomplete because
"a singularly gifted blind man or woman can be found doing work which
others — even those experienced in work with the blind — would consider
impossible for a blind person. Thus we know of a highly successful blind
scientist in atomic research, an equally successful blind chemist, and a
physicist, and I know myself of a totally blind man who owned and ran
the largest bookstore in a city with almost half a million population —
and he really did run it successfully" (Lowenfeld, 1956:12) * The fact
that even those experienced in work with the blind would consider these
occupations impossible for a blind person should have sobering implica-
tions.
It must also be remembered that employability is not related in a simple
way to degree of disability, that many unforeseen social as well as personal
forces may combine to open up opportunities for even the most severely
disabled. There is the enlightening fact, uncovered in Click's study of
adults with cerebral palsy (1953), that of those whose disabilities were
categorized as mild, 7 percent were employed as compared with 22 per-
cent of the moderately and 24 percent of the severely disabled.
The question can even be raised as to whether employability should be
the only criterion for deciding whether a person should enter a given
program. It is entirely possible, for example, that the aforementioned
graduate student with cerebral palsy would have made productive use of
her training though not gainfully employed in the usual sense. If she could
laboriously use an electric typewriter to be graduated summa cum laude
and achieve a master's degree, surely her psychological knowledge could
find some outlet useful to community life. The possibility of volunteer
work and of self-employment enormously extends the avenues toward
productive use of professional training and need not be denied because
of emphasis on competitive employment.
* From B. Lowenfeld, Our blind children, 1956. Courtesy of Charles C
Thomas, Publisher, Springfield, 111.
The Client as Comanager in His Rehabilitation 349
This point of view does not, of course, decry vocational counseling for
persons with physical disabilities. But the vocational and educational
counselor cannot with impunity make the decision as to whether or not
the client should enter one or another program because of his physical
limitation. Instead, the counselor should assist the client in deciding the
course of his destiny by making available necessary information and by
helping him come to terms with basic issues involved in the choices. A
good example of such mutual sharing in the process of vocational counsel-
ing appears on page 351. To be sure, there will be instances where hind-
sight will prove the client's errors, but there will also be instances where
the counselor's misgivings will not have been borne out.
Seidenfeld has made a special plea for the point of view supported here,
commenting that "unfortunately a number of psychologists working in
medical programs are called upon not infrequently to make 'psychological
diagnoses,' job suitability predictions, appraise personality characteristics,
etc. These requests are generally made in good faith and are based upon
the assumption of the physician and others, that such information at hand
should make it possible to decide for the patient what his whole future
should be like. Such an idea is obviously in error for it fails to take
cognizance of the fact that the most important element in the entire
matter is what the patient can and will do to make his own future"
(1948b:241).
Whether or not one agrees with the particular conclusion concerning
vocational guidance, the general point should be taken seriously by all
rehabilitation workers — namely, that the lack of omniscience on the part
of the counselor gives additional support to the principle that the adult
client should be a key planner in his rehabilitation. The point could have
been illustrated by many other areas, as, for example, choice of a
prosthesis or even selection of surgical methods where there is something
to be said for several alternatives.
Finally, there is the important question as to which issues belong
rightfully within the inviolable domain of the adults directly involved.
This is clearly a matter of values, of prerogatives, of rights that should be
Interfered with only in the most particular and dire circumstances. An
txample, the question of institutionalization, will illuminate this point.
The professional person needs seriously to consider whether he is ever
justified in insisting that institutionalization of a child is the only reasona-
ble course of action. If the answer is in the affirmative, he should try to
become clear as to conditions, in principle, which warrant such a drastic
decision. He must remind himself that at best it is difficult for an outsider
to judge when the care of a child, however feebleminded or physically
incapacitated, is too much for a family, for their love and concern may
so lighten the burden that what to others may be an unwise expenditure
350 Physical Disabilify — A Psychological Approach
of family resources may to the parents be simply taken as a matter of
course. To be sure, the parents should be kept informed of the possibility
of institutionalization, and any misinformation should be corrected. In
time they may agree that institutionalization is the only alternative, but
then it is their decision and not that of anyone else. Sometimes, of course,
the parent fairly pleads for the recommendation of institutionalization,
fearing to take the responsibility for such a course of action upon himself.
Certainly recommendation in such cases is not necessarily contraindicated.
But the right of the professional person to recommend institutionalization
when the parent is opposed to it should be seriously questioned. The
following situation is not uncommon and can well be pondered from the
point of view of "rights":
Mrs. Brown is completely unable to accept the recommendation of placing
Susan, age five, in an institution for the feebleminded. She can admit only that
Susan is retarded in physical functioning and speech. She now refuses to believe
that the doctors at the center have been interested in her child and that they
tried to help her the past three years. . . . [White, 1955:487].
Some persons may regard many areas as falling within the "inalienable
rights" of the individual. Choice as to having more children, even defec-
tive ones, may be so regarded, as may choice concerning living conditions,
vocational endeavors, and medical care. The principle of self-determina-
tion may be so highly prized as a value by some rehabilitation workers
that only in the most unusual circumstances would they feel compelled
to defy the wishes of the client. Other specialists see a much narrower
zone for decisions that are inviolably the client's. In any case, every
professional person must face the issue as to whether he has a right in
the particular situation to make decisions or even in some cases to offer
recommendations. On p. 357 we shall consider circumstances in which
the client cannot or should not be a key planner in his rehabilitation.
CLIENT AND COUNSELOR AS PART
OF MANAGEMENT ILLUSTRATED
The specific approach used to encourage comanagement will depend on
the setting, the character of the problem, and personality factors in the
counselor and in the client. Moreover, because of strong resistances to its
actualization on the part of either the counselor or the client (see pp.
361-363), the active participation of the client generally does not come
about naturally but rather has to be developed.
The following approach, used successfully by Garrett (1955) for
vocational guidance with cerebral palsied adults, is exemplary:
The Client as Comanager In His Rehabilitation 35!
In this method a large sheet of paper is used, divided down the middle with
"Assets" on the left column first and "Liabilities" on the right. Jointly counselor
and counselee explore whatever both know about the chent, carefully Usting
them in the appropriate column. Suitable items for Usting are . . . ability for
self-care, physical capacities, mental abilities, emotional status, vocational
opportunities, hopes, ideals, aspirations, preferences, and similar data. The
listings are made in terms comprehensible to the client and he may even be
encouraged to do the writing. Care should be exercised lest the "Liabilities"
column be greater than the "Assets" although a realistic appraisal of client
strengths and weaknesses will almost always reveal more ability than disability,
especially with those to whom this technique would be applicable.
When the listing has been completed, occupations under consideration are
then compared in detail with each asset and liability and an informal "score"
of so many assets and so many habihties is obtained. When all of the occupa-
tional groups have been completed, a rough scale of values in terms of
suitability of the occupations is ready. Usually the client is ready after such a
process to choose wisely, reaUstically, and with satisfaction to himself since he
has been an active partner in the process.
In this procedure, the . . . individual analyzes himself, determines those
elements which have vocational significance, evaluates their specific importance
to a given job, sorts and shifts the results of the process into a particular
occupational pattern and determines that which suits him better than others.
This process is dynamic and thus a guard against the . . . client remaining,
dependent, detached and avoiding reality whether of disability or of work. . . .
In this process the counselor makes it clear that he does not have the answers
and emphasizes this by the mutual working through of the problem [pp. 452-
453].
One could hardly accuse the counselor in the account above of having
been passive. Guidance was given, but a guidance which allowed the
client, even encouraged him, to explore those aspects about himself which
had vocational significance, to examine the total situation with respect to
particular occupations, and to determine which plan suited him better
than others. The conclusion that "usually the client is ready after such a
process to choose wisely, realistically, and with satisfaction to himself" is
not to be taken lightly.
As a corollary to the principle of comanagement is the suggestion that
the client, whenever it is feasible, be involved in staff conferences on his
own case. This proposition has been suggested as a problem for research
with respect to the parent's participation (see pp. 292-293). The points
made in that connection apply also to the client himself as a participant
and need not be repeated here. It is notable that efforts to include the
person in such an important matter as a conference about himself are
appearing on the rehabilitation scene. In one large rehabilitation center, it
is reported that after preliminary interviews and examinations by various
352 Physical Disability — A Psychological Approach
specialists, the patient, early in his stay at the center, attends a staff con-
ference at which all members of the professional visiting and consulting
staffs are present: "Each person presents such of his findings as are
pertinent and nonconfidential in the presence of the patient. These are
discussed with the patient participating, and feasibility and length and
type of rehabilitation training are estimated" [Rusk and Taylor, 1946:95].
Eventually, after more experience and research on this problem have
been accumulated, students will be schooled in how to participate in and
conduct conferences in the presence of the client. Until the nature of such
conferences is better understood, we are in a poor position to instruct
others as to what variations are appropriate to different purposes and
circumstances.
Another example of involving the client as part of management may
help give meaning to the fact that this principle has general application.
A prosthetics specialist tells his patients:
We cannot recommend a limb untU we get to know you. There is no such
thing as a "best" limb. The limb that is best-suited to the needs of one indi-
vidual may be entirely unsatisfactory for another. The type of work you do,
your personality and temperament, and the accessibility of a satisfactory limb
fitter to make necessary adjustments are but a few of the factors which must
be considered. // is also important from a psychological standpoint that you
yourself make the final selection. It's your limb, and you are going to wear
it [Rusk and Taylor, 7946.142, italics added].
Of course, enormous variability in just what is done and said is possible
within the comanagement role of counselor and client.
The belief that the principle of comanagement has general applicability
helps to reveal instances where the principle is violated to the detriment of
the goals of rehabilitation. Such instances also make us appreciate how
much easier it is for the counselor to direct, determine, and decide than
to share mutually these management functions, for in spite of best inten-
tions, one often slips into the role of "boss."
The following remarks addressed to a group of professional persons
represent the thinking and practice in many rehabilitation facilities. They
have to do specifically with vocational counseling, but the objectionable
principle, implied by the italicized phrases, underlies all too often the
procedures in the various branches of rehabilitation:
Through a preliminary interview with the client and by studying reports
from other agencies, the counselor learns of the disabled individual's desires,
needs, and problems. This is followed by a general medical examination and
any specialty examinations which may be necessary. The next step is for the
counselor to arrive at a vocational diagnosis. This is based upon a review of
The Client as Comanager in His Rehabilitation 353
medical data and the case study, and an appraisal of the client's aptitudes,
abilities, interests, and background including social, economic, and psychological
factors. The plan may include one or more of such services as surgery or other
medical care, artificial limbs or other appliances, training for a job, occupa-
tional tools, placement, and follow-up to efi'ect adjustment [Italics added].
Our main point is that both the counselor and the client should learn
of the client's desires, needs, and problems and that both should arrive
at a vocational diagnosis. The plan evolved should be the product of the
joint thinking of the rehabilitation team, of which the client himself is a
key member not only as the object of study but also as the one who casts
the deciding vote (see pp. 357-361 for exceptions).
To take another example, let us examine the following statement:
Preferably prior to an operation, or at least as soon after as possible, the
surgeon, the medical social worker, and any other members of the rehabilita-
tion team who are involved should start to build insight and understanding on
the part of the patient into the problems he faces.
This advice seems to be most commendable, but how much more com-
mendable it would be if these specialists were advised to ". . . start to
help build insight and understanding on the part of the patient." After
all, who works at the job of coming to grips with the patient's problems,
of trying to understand them? Who lies awake at night thinking of the
"ups and downs," the "ins and outs" and where it all will lead? The
specialist may, at times, but we can be sure that the patient does so far
more persistently. We must not forget that insight is built up by the
person himself with the help of outsiders if he is fortunate, but only with
their help. The process goes on within the client, and without his active
participation it becomes dissipated for lack of stimulation. "To help build
insight" reflects the emphasis that is necessary. When the specialist is said
"to build insight," there is a displacement of the primary causal agent to
the outsider.
The last sentence in the following quotation from a booklet addressed
to amputees in the hospital shows clearly how one-sided direction by the
professional person often unnecessarily and perhaps unwittingly creeps
in: "If you are going to turn misfortune into a valuable asset the time to
start thinking about your future is while you are still in the hospital. Do
not wait until you are ready to leave the hospital. The doctor, the social
worker in the hospital, the rehabilitation counselor in your district are
ready to answer your question, 'where do I go from here?' " Surely, the
question of "where the patient goes from here" can be worked through
only with the patient's full participation. Why not, therefore, state the
matter in some such fashion? To assert that the doctor, the social worker.
354 Physical Disability — A Psychological Approach
and the rehabilitation counselor are ready to answer this question is to
place the reins in their hands, with the patient at best becoming a back
seat driver.
Endless examples of the spoken and written word addressed to patients
or to the professional person, to say nothing of hospital and other pro-
cedures, could be presented to demonstrate the easy error of subordinating
the client to the position of one who should comply with directions and
advice. This error is so "natural" (see p. 362) that it is essential to
take specific measures to discover and thereby correct it. Just as any ex-
perienced writer corrects his first draft extensively, examining every
paragraph and sentence from the point of view of grammar, readability,
coherence, etc., so the rehabilitation counselor must conduct an ongoing
examination of his words and deeds to check whether they imply in any
way that he is the knower of all things or that he is the main actor, with
the client acting as the supporting cast. The counselor must always be on
guard lest he become so absorbed with procedural rules and principles
that the reaction of the client is ignored. After all, the real test of effec-
tiveness is what is happening to the client.
FURTHER IMPLICATIONS OF THE PRINCIPLE
OF COMANAGEMENT
Terminology as a Problem of Communication
If the client is to be encouraged to assume a leadership role in the
management of his disability, it is important that the counselor use
language that is comprehensible to the client. Too often the specialist is
unnecessarily obscure. A study by Stratton (1957) recognizes this problem
and points up certain precautions as a guide for the professional person.
It measured, by means of a vocabulary test, knowledge of tuberculosis
concepts by patients hospitalized with this disease. More than three-
quarters of the patients had no understanding of the following words:
lesion, function, study, thoracoplasty, resection. Less than half the sample
had a good understanding of these words: germ, spot, fluid. Words com-
prehended by four fifths of the group were: sputum, negative sputum,
positive sputum, clearing, gastrics, fluoroscopy, bronchoscopy. More than
half the patients knew the meaning of the terms: belly gas, pneumoperi-
toneum.
The main conclusions were: (1) The professional person should use
words that are as concrete as possible, relate directly to situations which
the patient experiences, and are more common and less technical. In
accounting for the fact that some of the most widely known words were
The Client as Comanager in His Rehabilitation 355
long and technical whereas some of the least-known words were short, the
investigator concludes that direct, personal, concrete experience with a
word appears to be a more important factor for the patient's understand-
ing than the length or technicality of a word. (2) Care must be exercised
in simplifying technical terms, for although the specialist knows what he
means when he uses, for example, the figurative term "bug" for "germ,"
many patients take this literally and visualize a many-legged creature
chewing on their lungs. (3) Anxiety may easily be created in a patient
when the specialist uses terms that are misunderstood. For example,
"imagine the feelings of a patient who is told that he has a spread of
disease if he believes, like one patient, that spread of disease means
'cancer,' or if, like another patient, he thinks that spread of disease means
'the lungs are about ate up' " (p. 42) . (4) Finally, the results strongly
indicate that one cannot assume that the more intelligent and better
educated patient has a much better understanding of medical vocabulary
or that the patient hospitalized for a protracted period is a great deal more
sophisticated in terminology than the new patient. In fact, nothing should
be taken for granted about the patient's knowledge of the disease and
words used to describe it.
Communication and understanding are also facilitated if the patient
himself is encouraged to learn some of the technical terms and concepts
related to his disability. Once the patient's role as comanager is accepted,
it becomes natural that, like a new foreman, he share in "on the job
training." Simply written and well illustrated explanatory pamphlets can
be of great value in this connection. Fortunately there is a growing collec-
tion of good materials which could be used for such purposes in hospitals,
clinics, and schools.^ Discussion of written material with the patient, if
possible in groups, provides the opportunity for further clarification of
misunderstandings and, what is of the highest value, for the development
of adjustive attitudes toward disability.
It would be a mistake, of course, to place undue emphasis in the
rehabilitation program on the acquisition of technical terminology and
knowledge, for certainly such factors as underlying attitudes between
counselor and client, hospital procedures, and family cooperation are also
crucial. Nevertheless, the problem of communication as such does suggest
not only that specialists must be made aware that what are obvious ex-
pressions to them may be unknowns to the client, but also that special
5 For example, there is the pamphlet prepared in cooperation with the
American Heart Association under the title Know Your Heart (Blakeslee,
1948). There is also the series of brochures dealing with selected disabilities
under the title of Patient Publication, inaugurated by the Institute of Physical
Medicine and Rehabilitation (1957). The first in the series is called a Primer
for Paraplegics and Quadriplegics.
356 Physical Disability — A Psychological Approach
training is indicated in the use of language which does in fact com-
municate what is intended. Cantor (1956), in discussing specific ways in
which the anxiety of the patient may be alleviated, mentions certain
written materials designed for the patient that can be of great value and
also offers concrete examples of "good" and "bad" descriptions by the
physician of the illness and postoperative course. Such discussion is com-
mendable and points up the need for specific training on matters of com-
munication. The research recommendation made by Barker et al. (1953)
should be heeded, namely, that increased knowledge is needed as to the
kind of information useful to patients and the manner of presenting this
information. "One can foresee the day when physicians [and other prac-
titioners] will be schooled in ways of informing patients of conditions
confronting them in terms adapted to the comprehension and emotional
needs of the individual" (Barker et al., 1953:316).
The issue raised here also calls into question the common practice of
making a mystery of a pharmacologic prescription by the use of Latin. It
may be desirable in some cases to deceive the patient or to keep certain
information from him, but the isolated case is never a justification for
generalizing to the whole.
The Importance of Clarifying fhe Situation
Terminology is one aspect of the broader problem of clarifying the
situation to the client. Barker et al. (1953:312-316) view the usual
diagnostic and treatment situation as a new psychological situation for
the patient, producing such behavior as conflict, caution, emotionalism,
exploration, suggestibility, and vacillation. They point out that much can
be done to remove the conditions causing this sort of behavior.
Among the more evident principles is "letting the patient know what
will happen when." Except for considerations that may justify conceal-
ment (see p. 357), this principle can do much to dispel the anxiety that
thrives on the unknown. Janis (1958) who studied patients undergoing
surgery, presents several lines of evidence supporting the importance of
authoritative information concerning the nature and course of treatment in
warding off fear (Chap. 25).
The following memory of an incident that occurred in childhood
unfortunately also has countless parallels in the experience of adults in
treatment situations. How much needless anxiety could have been averted
if time had been taken to inform Raymond, age 8, of the nature of the
examination:
. . . [the doctor] replaced me on the table and measured me. So far nothing
bad had happened to me, but I was still afraid. Each time he lifted me to
The Client as Comanager in His Rehabilitation 357
change my position I was sure that he was going to use on me that terrible con-
traption that hung from the ceiling. I wanted to beg him not to, but I thought
that I had better be quiet and not remind him of it. At last, while I was still
unharmed, he turned to Mother and said: "Dress him, please" [Goldman,
1947:21].^
Certainly, adequate communication consumes time. And realistic pres-
sures of time as well as energy limitations tend to minimize communica-
tion between practitioner and client. Nevertheless, even the harried
counselor must regularly pause to remember that often simple and brief
explanations can relieve anxiety. Davis (1958) presents a valuable discus-
sion of the interplay of diagnostic, professional, and institutional con-
straints, which lead therapeutic personnel to erect barriers against the
communication of relevant facts about the illness to the patient and
family.
Barker et al. also call attention to office and hospital practices that
serve to remove the unknown (i955.'312-316). In certain dental clinics,
children are allowed to familiarize themselves with dental equipment and
procedures before they require dental treatment. Visits by expectant
mothers to labor and delivery rooms are increasingly encouraged in
medical practice. Even the space arrangements for medical equipment
and procedures have a psychological impact. It makes psychological sense
to raise such questions as: Should control panels in the radiologist's office
be exposed or concealed? Should there be a common waiting room for
patients as opposed to private rooms? "These questions are not related
to the patient's comfort only. The possibility of beginning treatment early,
when therapy is most effective, depends upon lowering resistance to
securing treatment. Likewise, the therapeutic effect of many treatments is
undoubtedly influenced by the emotional reactions of the patient" (Barker
etal.,1953:ZU).
Condlfions for Withholding Information and Imposing Decisions
The problem of communication leads ultimately to a specific and
practical question: Are there not times when information ought to be
withheld? So broad a question is bound to receive an affu-mative answer,
but in the critical consideration of its specifications insights can be found.
Certainly acute illness and trauma are states that preclude full partici-
pation on the part of the client. Physically and psychologically the client
may be unable to attend even to the general circumstances of his condi-
tion, let alone the details concerning etiology, treatment, prognosis, and
6 The selection from Raymond Goldman: Even the Night, Copyright 1947,
The Macmillan Company, is used with the permission of the publisher.
358 Physical Disability — A Psychological Approach
future planning. His best medicine may be his conviction that he is in
the hands of competent specialists interested in his welfare. This reas-
surance releases his already overtaxed adaptation resources for the main
and immediate task of coping with the physiological trauma. Even in
these circumstances, however, the patient needs to know more than is
commonly assumed. He should be informed of what is happening — for
example, that he is being taken to the hospital, that he is being prepared
for a blood transfusion, that doctor so and so will operate. This can be
done in a simple and reassuring manner without the opinion of the patient
being solicited. A main value of such communication is that even if the
facts presented are not really comprehended by the patient in his
debilitated state, it conveys to him that he is, after all, a respected human
being and not an object — a difference of such psychological import that
it must not be passed over lightly.
If the condition has a poor prognosis, even ultimate death, should the
patient be told? The experts are themselves divided on this question, with
perhaps an increasing majority leaning toward the afl&rmative. But even
then it is generally acknowledged that there is really no one answer, since
it depends not only upon the type of person with whom one is dealing but
also upon such factors as his age and family circumstances. In a panel
discussion of this problem as related to cancer, the following pro and con
points were made (Cantor and Foxe, iP56;204— 208).
Pro:
• Most patients who undergo radical surgery of the face, breast, or any
visible part of the body know, or what may be worse, suspect, that they
have cancer anyway. The large majority live well with this knowledge.
Why, then, should one embark on the surreptitious approach in the case
of an internal tumor?
• Besides, the patient must be informed of early symptoms of possible
recurrence; he will be far wiser if he has knowledge of the original process.
• In the case of a fatal cancer, unless he understands the problem, the
patient will be more inclined to seek the services of quacks as he goes
downhill.
• The adult patient with a cancer of poor prognosis needs to know in
order to arrange his affairs wisely.
• When the physician hesitates to speak out, he usually acts a little
guilty, failing to look the patient in the eye and shifting his story. His
whole manner is conducive to the worst fears of the patient and the
poorest doctor-patient relations.
• Cancer, with all its publicity, is much on everyone's tongue nowadays,
and with medical advances, hope can be maintained even in the worst
cases.
The Client as Comanager in His Rehabilitation 359
• A patient has a right to know the truth when he asks a direct ques-
tion.
Con:
• To most people, cancer means an inevitable and miserable end, and
patients, even on their deathbed, should never be told they are dying.
• The issue is not a matter of telling the truth, for even those who
advocate openness will not deny the importance of glossing over certain
facts and stressing the more positive.
• It depends entirely on what you think the patient wants to know.
Since most patients do not want the diagnosis presented to them flatly,
the matter should be approached obliquely, in some such manner as "This
could be a serious condition. I won't know until I have made my studies,
but it needs surgery."
• There are a good many patients who have lived comfortably with the
knowledge that they had some serious illness, but as soon as the diagnosis
of cancer was given them, they did not fare well at all.
Of the six physicans on this panel, only two leaned toward the position
that by and large knowledge of cancer should be shielded from the
patient, and only a minority of the medical audience favored this belief.
At the same time the panel members agreed that an unequivocal "always"
or "never" to the original question was impossible, since special factors in
the individual case may require special handling.
What does the patient himself think about the divulging or concealment
of information? There are no data, as far as we know, concerning cancer,
but there is a study reported by Harrower and Herrmann (1953) concern-
ing multiple sclerosis, a disease that attacks the central nervous system,
that is often progressively and seriously disabling, and that ultimately may
lead to death. Of 300 patients with this disease, 90 percent believed that
they should be told. Their reasons were: to be able to plan one's life, to
be free from the strain of uncertainty, to avoid spending money uselessly,
to be able to take better care of oneself physically, and to remove the fear
that one might be neurotic. In effect these patients said, "If I am to guide
my life satisfactorily, I need to know." Of 34 patients with multiple
sclerosis who were not told their diagnosis only 9 percent were encouraged
whereas 91 percent were discouraged.
Of course it would be helpful if there were some way to identify
reliably those relatively few individuals who would fare better under the
"bliss of ignorance." On the basis of the personality characteristics of
patients with multiple sclerosis who wanted to be kept informed and of
those who did not, it was concluded that the less differentiated, emotion-
ally less mature persons are not concerned about medical details whereas
those persons who are more intelligent and have more mature personalities
360 Physical Disability — A Psychological Approach
become more apprehensive when information is withheld from them
(Harrower and Herrmann, 1953). On the basis of his work with surgical
patients, Janis {1958) describes two types of patients requiring some form
of quasi-therapeutic interview before information can be of benefit. The
"overcontrolled neurotic," who tends to manifest low fear in generally
threatening situations, needs help before information will activate the
"work of worrying" and thereby motivate him to deal in his fantasy with
the sources of danger and discomfort that he may encounter so that in a
moment of crisis he will be better prepared. The "undercontrolled neu-
rotic," who tends to show high fear in even mildly threatening situations,
will need help before information and the work of worrying can effectively
serve the function of psychological preparation.
The following conclusions, based on the preceding data and on certain
hypotheses considered elsewhere in this volume, seem warranted:
1. In by far the majority of cases it is wiser to inform the patient of his
condition than to conceal it.
2. Certainly where the patient is mature as a person, this course carries
little risk.
3. Where the patient appears markedly immature and dependent, one
may act more cautiously; but even in this case, if it is incumbent that the
patient act realistically, sharing the state of affairs with him under the
sustaining power of hope may be more efficacious.
4. Facing the situation realistically need not deny hope, for the two
are psychologically not incompatible. Moreover, hope for a possible
favorable turn of events may even sustain one's resources in acting
realistically in terms of the probable turn of events.
5. Further research is needed to enable the practitioner more reliably
to select those cases where concealment is desirable. We ought not rest
content with speculation, for this is an area amenable to investigation.
Concealing difficult facts from children, for example, may or may not
have the consequences we assume. (Our prejudice, probably shared by
most people, is that children should be shielded, but let us remember
that this is a prejudice until put to more objective test.)
6. As in all matters of counselor-client relationships, the effects of dif-
ferent rules of behavior or procedure depend on the attributes of the
counselor as well as of the client. If the counselor has an abhorrence of
cancer, multiple sclerosis, or death, forces in him will resist mention of
these facts. Or if the counselor devaluates the person who is ill or who
has a disability, he will tend to overestimate the vulnerability of the
patient to distressing information. These, by the way, are the kinds of
hypotheses readily subject to experimental test.
The question concerning withholding of information can be paralleled
The Client as Comanager in His Rehabilitation 361
by one concerning decision-making — namely: Are there not times when
the cHent ought to be told what to do? The generality of this question
again evokes a positive reply and again it is in the specification of cir-
cumstances that understanding is achieved. The situation of the acutely
ill person, already considered in connection with the dissemination of
information, applies equally to decision-making.
There are also times when the client, though not acutely ill, needs to be
told what to do and welcomes such direction. The conclusion that the
client needs surgery, for example, cannot be left up to him (unless there
are at least reasonable alternatives). Such a decision presupposes a body
of fact and experience which the patient cannot possibly hope to master
in the time at hand. Moreover, although the patient or parent may have
been dreading the verdict, he often feels relieved that positive action is
being taken. In this situation the decision is made by the specialist and
accepted by the patient.
But what about a client's refusal to accept the decision of the specialist?
Certainly in instances involving life and death many physicians would
justify the use of all sorts of efforts, even ruses, to achieve concurrence.
Some physicians, however, would still reserve to the individual the right
of self-determination. In less critical cases there is again variability of
reaction, some withdrawing from the case when the patient refuses to
accept the medical plan, and others continuing treatment with second-best
procedures. Among the factors that contribute to this difference is the
vital one concerning inalienable rights of the client (see pp. 349-350). It
is therefore incumbent upon the specialist to reach an understanding of
circumstances which, according to his values and standards, warrant his
control over decision-making. This understanding cannot be achieved
casually, for it presupposes not only a serious evaluation of the problem
of comanagement in rehabilitation but also a coming to terms with one's
own values.
FACTORS HINDERING THE MUTUAL SHARING
OF THE MANAGEMENT ROLE
Conviction that active participation on the part of the client favors the
ultimate goals of rehabilitation is, of course, essential for its effective
application. Many factors, however, serve to make its application dif-
ficult. Chapter 12 discussed factors in the parent and in the counselor
that impede a satisfactory relationship. These have application to the
relationship between a counselor and the adult client with a disability as
well. In the present context the discussion is recast to give prominence to
particular points and to introduce others.
362 Physical Disability — A Psychological Approach
Perhaps the most important factor that hinders management participa-
tion on the part of the client is his social-psychological situation. The
point has already been made that "help" in general frequently connotes an
asymmetrical situation in which the one helped occupies a subservient,
less powerful position. Rehabilitation services are special cases of a rela-
tionship involving help. Where a marked status differential exists, the
counselor occupies the position of a benevolent and authoritative parent,
protecting, guiding, and ordering, and the client occupies the position of ?.
child, naive, uninformed, and irresponsible, with negativistic and un-
realistic tendencies.
In these circumstances the attitude that the expert has the answers, or
at least should have the answers, is reinforced. The thought that the
answers themselves may frequently require the judgments and decisions of
the client is quite alien. Instead, it becomes natural for the counselor to
take over and to receive the credit for successful rehabilitation, although
in analyzing the conditions for such an outcome, the client should share
the credit.
Not infrequently, of course, the client expects and wants the counselor
to take charge of his case completely. And there are circumstances in
which such action is definitely advisable. The acutely ill person often does
not have the energy reserve, to say nothing of clarity of intellectual func-
tioning, to become actively involved in alternatives and decisions. On the
contrary, it may be important that he allow the therapist to take over
with full confidence that he will manage wisely. But the client's readiness
to shift responsibility to the therapist is also a second factor often inter-
fering with the goals of rehabilitation. Especially when the success of the
endeavor requires unsupervised and independent action on the part of the
client is it essential that he be brought into a directorship role as soon as
feasible. It is one thing if the patient while on the operating table yields
to the wisdom of the surgeon, for both literally and figuratively the
matter is out of his hands. But it is quite another thing if, during the
patient's convalescence, the doctor, the vocational counselor, or the physi-
cal therapist lays out the course of action without genuine consultation
with the client. Here the specialist cannot remain at the client's elbow to
see that the plan works. Aside from the question of motivation, it is
important to remember that the patient who is actively engaged in steering
his rehabilitation course is able to take into account circumstances and
facts which, if neglected, might lead to dead ends or at best to detours.
The needs of the specialist are also an important determinant of his
role. If the specialist has a need to assert himself, to flaunt his knowledge,
to buttress his status, then the authoritarian role not only is satisfying but
is sought out. There is also the specialist who does not enjoy or who even
may become anxious in a real give-and-take relationship. He prefers the
The Client as Comanager In His Rehabilitation 363
more impersonal contact with his client that is possible in an authoritarian
role.
One factor impeding comanagement in rehabilitation is so realistic that
it is difficult to circumvent. It has to do with time shortage, with the need
to spread rehabilitation services to as many people as possible. The un-
fortunate fact is that involving the client in a comanagement role takes
more time than having the specialist accumulate the data and present the
prescription. One can retort that time is saved in the end, but the im-
mediate pressures in the light of severe personnel shortages and staggering
numbers of clients in need make expedient the authoritative role of the
expert. One of the solutions lies obviously in the training of more special-
ists. Another lies in the use of known techniques which, among other
advantages, make possible more efficient use of the specialist's time.
Group counseling and guided reading by the client are examples. The
use of special personnel, such as social workers, who are able to pave the
way for real participation on the part of the client and to act as a mediat-
ing link between the client and an overburdened specialist is another
possibility.
Yet the point still needs to be underscored that, however pressured the
specialist may be, belief in the principle of comanagement can go far in
bringing it about. But just because it is easier to subscribe to the concept
of comanagement in principle than in practice, the counselor must ques-
tion at all stages in his relationship with the client whether in fact the
client is at the helm helping to steer the course of rehabilitation or
whether he is being paternalistically directed as a manipulatable charge
Vho is to follow through but not wonder why.
15
Chapter
An Assessment of the Field of
Somatopsychology
A LONG AND SOMEWHAT ARDUOUS PATH HAS BEEN TRAVERSED IN OUR
search for understanding some of the psychological aspects of disability.
Before some final statements are attempted, we shall review some of the
precursors that heralded current efforts in the broad area of deciphering
man by his physique. In the main they do not deal with somatopsychology
as such. They are mentioned, however, so that somatopsychology can be
seen within the perspective of the total effort to discover or impute
physique-personality relationships.
THE HERITAGE OF SOMATOPSYCHOLOGY
Since time immemorial, men have held firm beliefs concerning the
relationship between all sorts of physical attributes and personality. These
have ranged from the revelatory signs of bumps on the head, physiog-
nomic features, and body chemistry to the divinatory powers of the lines
on the palms of the hands and soles of the feet. The widely divergent
efforts have had the common goal of demonstrating that man's personality
can, in fact, be read from physical constants. Here we can present only
the barest highlights of some of the most relevant excursions dealing with
this problem.^
Physiognomy, a method which attempts to discern character and
temperament from the outward appearance of man, particularly from his
facial features, is one of the oldest of all body-reading systems. Treatises
on this first appeared in Aristotelian times and continue to appear today.
The long historical line, however, is not a monotonous repetition of points
1 Maisel (1953) has written a penetrating review of the various specific
attempts to read personality from physical signs. Briefer historical accounts of
"constitutional psychology" can also be found in Allport {1937) and Sheldon
{1940, 1944).
364
An Assessment of the Field of Somatopsychology 365
laid down earlier, for modifications were introduced that reflected the
beliefs as well as cultist trends of the times. Thus, when astrology was at
its height, man's countenance was linked to the stars.
The effort to specify the facial signs that betrayed personality was often
complex. Lavater, one of the most ardent eighteenth-century physiog-
nomists, devised an inventory of hundreds of facial types with their
corresponding personalities. Although primary emphasis was placed on
facial features, other parts of the body were not excluded. For example,
Lavater claimed that he could judge a person by the shape and movements
of his hands, portending the modern emphasis on "expressive movements"
(see p. 371).
Phrenology, historically one of the more important of the body arts,
was devised by Franz Joseph Gall, an early nineteenth-century German
anatomist. It was based on the assumption that man's faculties, over forty
of which were eventually posited, were localized within the brain in such
a way that the contours of the skull correctly mirrored their character.
For example, one of the presumed faculties was acquisitiveness, and it was
held that the corresponding external bump on the skull was prominent
in pickpockets. Although these notions, in their specificity, hold no cur-
rency today, the study of the brain itself, stimulated by the work of Gall
and his pupil Spurzheim, has led to important anatomical discoveries.
That body-reading systems had and continue to have interest far
beyond the academic becomes clear when their implications for crimi-
nology are examined. As far as we know, the uglier of two suspects always
tended to be considered the guilty one. The innovation of rigorous juris-
dictional procedures to hold in check such bias attests to this. Lombroso,
a nineteenth-century Italian physician who had a tremendous impact on
criminology, anthropology, and constitutional psychology, made the most
vocal and systematic attempt to prescribe a criminal physical type (1911).
He tied together presumed physical stigmata by a principle of atavism
which averred that the criminal was a throwback with degenerate mental
and physical features. Darwin's theory of evolution as expressed in the
then recently acclaimed Origin of Species provided the biological basis
for Lombrosian notions. The criminal could, so it was avowed, be detected
by physical features that pointed to his evolutionary inferior forebears,
such as large jaws, receding or apelike chin, harelip, etc. Although during
Lombroso's own lifetime the substantive content of his beliefs was dis-
carded by many, the underlying notion that there are physical charac-
teristics which, through one mechanism or another, are associated with
asocial behavior has persisted to the present, as for example in the work
of Sheldon (see pp. 367-369) and the less generally accepted work of
Hooton (1939).
In addition to the visible and predominantly structural aspects of
366 Physical Disability — A Psychological Approach
physique, events within the organism, notably the workings of the
"humors," were also held accountable for man's character. The humoral
doctrines were built upon the notions of Empedocles, the poet, philoso-
pher, and statesman of the fifth century before Christ, who considered
the universe to consist of four basic elements — air, fire, water, and earth
— each of which had special properties definable by the dimensions "dry-
ness" and "warmth." Air was warm and moist, whereas earth was cold
and dry. Hippocrates, the "father of medicine," who lived during the
same era, proposed that each of these four elements was represented in
man's body by a humor, the relative prominence of which determined the
individual's temperament. The theory evolved that men were sanguine,
melancholic, choleric, or phlegmatic, depending upon their internal
make-up, which in turn was related to the cosmic building blocks. For
example, the person who flared with temper, the so-called choleric per-
sonality, owed his disposition to one particular humor, yellow bile, which
corresponded to fire and its properties of warmth and dryness. Over the
ages, particular humoral suppositions underwent change, and though
modem thought has forsaken the four temperaments and their cos-
mological reference, our metaphoric language still reflects the humoral
beliefs of the past. We still refer to damp spirits and dry humor, to indi-
viduals who have gall and who are cold-blooded, to the jaundiced eye and
the splenetic personality.
Modem endocrinology, based on systematic test and observation, has
accumulated considerable knowledge about the bodily secretions that
stabilize functioning or create anomalies when there is imbalance. Cretin-
ism, acromegaly, diabetes, hyperthyroidism, and many other conditions
are due to faulty endocrine systems. Of this there can be little doubt. But
again the temptation to draw far-reaching conclusions regarding conse-
quent personality effects, conclusions based on supposition rather than on
systematic observation, has been more than some could withstand. A
person's readiness to anger, his state of depression or his happy-go-lucky
outlook, has been attributed to particular combinations and lacks in the
functioning of internal secretions.
Although serious research on the contribution of biochemical and
physiological processes to personality appears promising, we can only
agree with Maisel's (1953) conclusion: "Yet to reduce the phenomenon
of personality to the interplay of body juices amounts to little more than
a mechanical formulation of a human being — a complex entity whose
dynamic brilliance gives the lie to segmental simplism at every turn" (pp.
196-197) .2 No matter how important a role glandular and other physio-
2 Edward Maisel, Meet a Body, by permission of the Institute for the
Crippled and Pisabled,
An Assessment of the Field of Somatopsychology 367
logical phenomena play in personality formation, it is not likely that
they can ever claim the whole matrix of determinants, for surely such
psychological concepts as ideas about the self, beliefs concerning "oughts,"
expectations, and many, many others, as well as the sociopsychological
conditions underlying them do not seem to be negligible.
In disputing the extravagant claims of body-reading systems, investiga-
tors took advantage of the newer methods of science, notably those which
insisted upon adequate controls and the statistical treatment of sampling
and other errors. The accumulated evidence has virtually discredited all
the specific physical signs that had been used in times past as personality
indexes. Nevertheless, in spite of refinements of measurement and perhaps
greater appreciation of the human being as a complex whole, the under-
lying conviction that man reveals himself through visible aspects of his
physique has not been shaken. Several lines of investigation that dis-
tinguish the modern trend are described below.
CURRENT APPROACHES LINKING PHYSIQUE AND PERSONALITY
Among the most prominent and systematic efforts on the modern scene
is the work of Sheldon (1940, 1942, 1949) and his collaborators, gener-
ally referred to as "constitutional psychology." Sheldon's closest historical
ancestor was Kretschmer {1925), who described physique in terms of
four body types and related each to certain personality traits. For example,
Kretschmer's classification "asthenic," designating the long-limbed, slen-
der, narrow-chested person with underdeveloped musculature, was thought
to indicate a tendency to be shy, sensitive, and cold and to become
schizophrenic in the event of mental illness.
Sheldon's somatotype theory is far more complex than Kretschmer's
and allows for a greater variety of individual differences.^ Sheldon (1940)
considers three types of body build corresponding to the embryonic
layer that has shown predominant development: (1) The endoderm, or
visceral layer, which predisposes the person to a soft, round physique, this
component of physique being called endomorphy; (2) the mesoderm, or
muscular layer, which gives rise to a strong muscular physique designated
as mesomorphy; (3) the ectoderm, or layer involving the nerves and
sense organs, which favors a slender, delicate physique termed ecto-
morphy. The variability in human nature is provided for by rating these
dimensions along a seven-point scale with reference to five areas of the
body and by rating several secondary components of physique such as
3 For a relatively brief but clear and comprehensive review of Sheldon's work
see Hall and Lindzey (1957).
368 Physical Disability — A Psychological Approach
"dysplasia" (a measure of the unevenness of the three primary com-
ponents as they appear in different regions of the body). It has been
possible to achieve adequate ratings of somatotype by the use of seventeen
physical measurements derived from photographs and such additional
data on the subject as age and weight.
The second aspect of Sheldon's task required a system of rating tem-
perament that could then be correlated to the somatotype {1942). After
a series of exacting studies, three components of temperament were
isolated, each being defined by 20 traits that are related to one another
and negatively correlated with the traits belonging to the other two
temperament clusters. Viscerotonia, for example, is characterized by a
love of comfort, relaxation, food, sociability, etc., somatonia, by a love of
vigorous physical activity, adventure, risk taking, etc., and cerebrotonia
by discomfort in social situations, secretiveness, inhibition, etc. Only after
long acquaintance is the subject assigned ratings of 1 to 7 on each of the
60 traits that serve as criteria for the 3 components of temperament.
Studies concerning the degree of association between temperament and
physique based on Sheldon's somatotyping and temperament scale have
revealed substantial correlations between the two, although the findings
of scholars not associated with Sheldon's laboratory have been less spec-
tacular than those of Sheldon himself. Thus the person whose somatotype
is high in mesomorphy is inclined to (though definitely not compelled to)
display the temperamental characteristics of somatonia.
Sheldon has also applied his measurement instruments to the study of
delinquents (1949) and is convinced that physique and the associated
temperament do differentiate delinquents from normals and that they even
differentiate subvarieties of delinquents. Thus Lombroso, whose theories
of criminal physical type were cast aside by the sophisticates of modern
science and methodology, is being somewhat vindicated by Sheldon's
work, although the theory of atavism remains unsupported. Sheldon's
complex indexes of basic physical components seem to show distributions
according to one's asocial history, at least to some degree. Thus, among
delinquents, Sheldon has found a much greater elevation of mesomorphy
and a marked absence of ectomorphy.
Sheldon has also found a relationship between his components of
physique and psychiatric diagnosis. In addition, the evidence that there is
some relationship between constitutional type and propensity to certain
kinds of organic disease, such as cancer, gall bladder disease, and duodenal
ulcer appears to be accumulating. The evaluation of Sheldon's contribu-
tions by Hall and Lindzey is offered here as a concluding statement:
". . . an over-all appraisal of the many studies conducted since Sheldon
began his work will lead the reader to accept the existence of a significant
and interesting relation between physique and personality, but will leave
An Assessment of the Field of Somatopsychology 369
him unconvinced that the relation is so close as Sheldon seems to imply"
(/957.-374).*
How Sheldon's findings bear upon the relation of physical disability to
personality is still unclear. If it will be demonstrated that certain types of
disability, congenital or acquired, are associated with particular somato-
types, a relation between physical disability and personality via somato-
typology would seem indicated, since somatotype and temperament are
associated to some extent. As we have already noted, however, with the
measurement instruments used in disability research to date, disability
groups have not been distinguishable by personality criteria with any
degree of consistency, and the overlap between groups studied appears to
be the prominent finding. It has yet to be shown that physical disability
groupings of the sorts we have been considering represent anything more
than phenotypic classifications with little diagnostic significance for
inferring temperament or personality.
Although Sheldon stresses biological determinants of behavior and
personality, he by no means excludes other factors mediating physique
and personality. This is especially important in the context of our problem,
that of relating physical disability to personality. Sheldon also acknowl-
edges the possibility that a person with a particular physique achieves
success in certain activities and interactions with people, which behavior
then becomes reinforced. Other people with similar physiques have
similar experiences and therefore develop similar patterns of behavior and
temperament. Sheldon also recognizes the fact that a given physique
carries with it cultural expectations of how the person will feel and behave
predisposing the individual to conform to that role.
A second attempt to discern personal traits from physical constants
was initiated by the work of Brunswik and Reiter in the early 1930's.
Instead of dealing with isolated physiognomic features, which have been
shown to offer little, these investigators attempted to discover how the
interrelationship between such factors as distance between eyes, length
of nose, proportion of mouth to chin, and so on affected various observers.
The subjects were asked to judge almost 200 schematized sketches on the
7 qualities: (1) Mood (gay-sad) (2) Age (young-old) (3) Beauty
(beautiful -ugly) (4) Character (good-bad) (5) Likability (likable-un-
likable) (6) Intelligence (intelligent-unintelligent) (7) Energy (energetic-
unenergetic) (Brunswik and Reiter, 1937). Judgments of physiognomic
or personality qualities were shown to depend upon the geometric features
varied in the sketches. For example, a high mouth produces the impres-
sion of gayety and youth, whereas a low mouth yields judgments of sad-
4 Reprinted with permission from C. S. Hall and G. Lindzey, Theories of
Personality. 1957, John Wiley & Sons, Inc.
370 Physical Disability — A Psychological Approach
ness, age, and bad character. Eyes that are far apart and a short nose
exert influences similar to those of a high mouth, though to a lesser extent.
The longest noses generally produce unfavorable impressions.
This experiment was repeated with feature-patterns arranged in pairs
and representing opposite extremes for each personality quality, as deter-
mined by the previous study. The subject had to indicate which of each
of the pairs presented reflected the quality in question. The results clearly
corroborated the earlier work (Samuels, 1939). Moreover, in still another
study the same judgments were elicited from subjects with brain disease
and subjects with mental illness (Halstead, 1951). Developmental and
comparative data were also collected by Brunswik, using children and
adolescents from predominantly white, predominantly Negro, Chinese,
and Indian reservation schools, the results again being borne out (Bruns-
wik, 1956:\12>). Thus, the physiognomic impressions of the geometric
features that were experimentally controlled appear to be highly general-
izable across populations including persons with brain damage and psy-
chosis as weU as differences in developmental level. Brunswik has sum-
marized additional studies in which the impression value of the eye region,
the mouth area, the hairline, and of the grooming of hair, beard, and
moustache were investigated by means of schematic faces (Brunswik,
7955.-114— 115). A similar approach, with representations of the full
human figure, has also been used (Brunswik, 7956.116-119).
When photographs of real people with facial features of the proportions
appearing in the schematized faces were judged, however, a marked drop
in uniformity of judgment occurred (Samuels, 1939). This result, together
with divergencies of the impressions of different photographs all having
the same facial measurements in terms of the variables studied, led the
investigator to conclude that there is a "relative lack of influence of the
Brunswik and Reiter cues in the real faces" (Samuels, 1939:25).
It must be remembered that the concern of these studies has not been
with the validity of the judgments but rather with the determination of
factors that influence the judgments. Although application to real faces
and people has still to be demonstrated, the approach appears promising.
After all, the art of caricature by emphasizing certain features in relation
to others seems to bring out the personality in the physical likeness.
Another direction of research interest is represented by the study of
what has come to be described as "expressive movements." Instead of
dealing with structural relations and body constants, the attempt here is
to view the more active aspects in the belief that these more vividly mirror
underlying personality dynamics. This belief is not without confirmation
in everyday experience; gait, hand movements, and facial expressions are
a language which we seem to understand whether it be solely relied on as
in stage pantomime or elaborated verbally as in drama and ordinary
An Assessment of the Field of Somatopsychology 371
interpersonal relations. A person whose jaw is set and who strides across
the room with hands clenched behind him gives an aura to his feelings
that is apparent without the aid of the deciphering measures of science.
Of the investigations that have contributed to the modern study of
expressive movements, the work of Allport and his collaborators is indica-
tive of both the general approach and the findings. (See especially Allport
and Vernon, 1933 and Estes, 1938.) In their series of studies the in-
vestigator recorded such indexes of behavior as strength of handshake,
handwriting, voice, speed of walking, amount of movement during natural
speech, and speed of reading. Two main problems were investigated : ( 1 )
In order to determine whether expressive movements of diJfferent parts of
the body, however functionally disparate, do indeed bear some resem-
blance to one another, they were intercorrelated. (2) In order to deter-
mine whether there is a congruence between expressive movements and
the attitudes, traits, values, and other dispositions of the "inner person-
ality," some of the indexes were matched with independently derived
personality sketches of the subject.
In regard to both these objectives, positive findings were obtained,
though the consistency was not absolute and the accuracy of reflecting
personality not strikingly great, (See also Wolff, 1943.) The results do
show that one's style of moving, his gestures, handwriting, voice, and
personality are interrelated, but only to some extent. This, of course, is
in line with the fact that all behavior is multidetermined. The style of
behavior is not solely a matter of idiosyncratic traits, for there is also the
role of sociocultural and biological determinants, which are more or less
nonpersonal in character, as well as the fact that transitory states of
moods and organic conditions, though affecting the immediate manner of a
person, do not necessarily affect the more enduring aspects of personality.
Besides, insofar as personality itself is not integrated in every aspect,
expressive movements as reflectors of personality could be expected to
show inconsistencies also.
Another approach in the never-ending search to find body correlates of
personality is represented by the scope of this book — namely, the field of
somatopsychology. In the following sections an attempt will be made to
reduce the findings scattered among the somatopsychological problems
already dealt with to the order of orienting principles and conclusions.
OVERALL FINDINGS OF RESEARCH IN SOMATOPSYCHOLOGY
Inconsistencies in Results and Their Usefulness
Inconsistency is fairly typical of the status of many of the findings in
the field of somatopsychology. Indeed, it is an integral feature of the
372 Physical Disability — A Psychological Approach
growth of all empirical sciences. As Feigl (1953) points out, "Factual
knowledge cannot attain either the absolute precision or necessity of pure
mathematics. The knowledge claimed in the natural and the social sciences
is a matter of successive approximations and of increasing degrees of
confirmation" (p. 9). Inconsistency of results, moreover, may be an
important finding; it may challenge the investigator to reappraise both
hypotheses and research techniques in an attempt to bring together the
divergencies.
An example of inconsistent findings in somatopsychological research is
the summary of 15 studies on blindness that have utilized personality
inventories (Barker et ah, ] 953:282).
1 . In 6 studies, both the subscale test scores and the total test scores are
in the direction of greater maladjustment for the blind as compared with
seeing groups.
2. In the other 9 studies, the visually handicapped did not consistently
fall significantly below seeing controls on subscale and total test scores.
3. Studies using the same tests produce different results. Of two studies
using the California Test of Personality, one showed that the blind scored
lower than seeing controls on social adjustment, and the second showed
the two groups equal in this respect. Of two studies using the introversion
scale of the Bernreuter Personality Inventory, one found that the majority
of blind subjects scored as introverts, whereas the other showed the blind
to be no diff"erent from the controls. Moreover, the investigators of both
studies note that test results and observational data were not in agreement.
Even the more sophisticated type of laboratory experiment, which
avoids certain methodological weaknesses common to the use of per-
sonality inventories, shows diversity of results to be the rule. This is well
illustrated by the review of studies on the goal-setting behavior or level
of aspiration of persons with disabilities. Some of the studies indicate that
the goal-setting behavior of the subjects who had a disability differed in
some way from their normal controls (Rotter, 1943; Mc Andrew, 1948;
Wenar, 1953; Rutledge, 1954). Others, however, found no differences
(Arluck, 1941; Heisler, 1951; Johnson, 1954).
Such inconsistency and diversity among findings force serious attention
to the dangers of overgeneralization. With respect to subject overgenerali-
zation, the matter can be put simply by the obvious although often ignored
principle that because certain subjects with the same disability show
certain reactions, it does not follow that all or most subjects with the dis-
ability behave similarly.
There is also overgeneralization of a different sort, behavior over-
generalization. Not infrequently, on the basis of one behavioral manifesta-
tion, conclusions are made as to the generality of that behavior; yet it xs
An Assessment of the Field of Sonnatopsychology 373
entirely possible that different situations would yield different results. An
interesting example is found in an experiment on rigidity in the personality
of deaf children (Johnson, 1954). The investigator used not one but
several different tests of rigidity. It was found that the relative rigidity of
deaf children as compared with their hearing controls depended on the
particular testing situation. The experimenter, therefore, was led to the
conclusion that "deaf children are not necessarily more rigid than hearing
children. . . . Deaf children may sometimes, in some situations, behave
less rigidly than hearing children" (p. 71).
This conclusion is far-reaching because it directs thinking to additional
situational and personal variables important for rigidity, which can then
be pursued in continued investigation. For example, the experimenter, on
the basis of the nature of the situations that produced "inconsistent"
results in relative rigidity between deaf and hearing children, hypothesized
that the deaf will be flexible in many situations that involve acute visual
perception (p. 75). The necessity of including an adequate sampling of
situations in research as well as an adequate sampling of subjects has been
urged upon psychological science by Brunswik (1947) and is referred to
as the problem of representative design.
Inconsistency and diversity among findings, in addition to alerting the
investigator against overgeneralization and toward the formulation of new
hypotheses, also force serious attention to one of the most important yet
least accepted principles in somatopsychology, namely that somatic
abnormality as a physical fact is not linked in a direct or simple way to
psychological behavior. Heterogeneity of reaction to crippling is a neces-
sary result. Possible underlying psychological factors, which might account
for the differences in behavior, must become the main focus of investiga-
tion.
General Results
The following summary is not designed to list factual details that have
been gathered in somatopsychological research. Rather we shall attempt
generalizations of some of the broad areas that have commanded interest.
1. There is no substantial indication that persons with an impaired
physique differ as a group in their general or overall adjustment (Barker
and Wright, 1954). (This statement does not apply to impairments of
clearly psychosomatic origin, though even in such instances the evidence
is far less consistent than might be expected.) Some studies show a some-
what greater number of persons with physical disabilities who have lower
adjustment scores than their controls but in most of these cases the dif-
ferences may well be experimental artifacts. At this time, it can be said
374 Physical Disability — ^A Psychological Approach
with considerable assurance that the great overlap in the level of adjust-
ment of physically handicapped and nonhandicapped groups is at least as
significant as the relatively small margin of difference found in some of
the studies.
This is not to say, of course, that most persons with physical disabilities
are well adjusted, any more than it is to say that most physically "normal"
persons are well adjusted. Good adjustment can refer to a conceptual
relationship between the person and the environment independently of
how it is distributed in the population at large. But the findings do point
strongly to the conclusion that most persons with physical limitations
make about as good a personality adjustment as do the nonhandicapped.
2. There is also no clear evidence of an association between types of
physical disability and particular personality characteristics (Barker and
Wright, 1954). Such folklore as that of the euphoria and hypersexuality
of the tuberculous and the paranoia of the deaf are not supported by
available data. Even in disabilities involving gross neural lesions, as in
cerebral palsy, individuals do not exhibit common characteristics of per-
sonality (Barker et ah, 1953:64; Cruickshank and Bice, 1955).
The following statement by Johnson (1950) with reference to stutterers
may be generalized with impunity at the present stage of our knowledge
to other physical disability groups. The statement is based on over 100
scientific studies of stuttering in older children and adults, and 6 investiga-
tions involving more than 200 young children, stutterers and nonstutterers:
"I believe any expert can safely be challenged to go into a room in which
there are 100 adult men and women and pick out the ten stutterers whom
we shall include in the group. He may use any tests whatever, except that
he may not hear anyone speak, nor may he obtain any information about
each individual's personality and mental ability so long as this information
in any way relates to the question of how the person speaks or used to
speak. I should be surprised if the expert could make significantly better
selections with his test than he could by means of the eenie-meenie-
minie-moe" (p. 7). The specific kinds of direct cues to be avoided, of
course, will have to be specified for the particular disability in question.
The same point has been made in a study of whether emotional dis-
turbance, when it occurs, assumes pathognomic patterns among children
with cerebral palsy (Miller, 1958). The children with cerebral palsy and
the physically normal children had been referred to a child guidance
clinic because of severe learning and behavior problems. The conclusion
reached was that if only test data on these groups were available, with no
identifying data as to the physical handicap, one would be unable to
select out the handicapped except as problems in perception and coordina-
tion existed. The test data gathered in the study included tests of intel-
ligence and projective tests of personality.
An Assessment of the Field of Soma+opsychology 375
It is not impossible, however, that better data will reveal general per-
sonality patterns associated with more precisely defined disability group-
ings. For example, in a broad and careful study of some personality
characteristics of epileptics (Arluck, 1941), it was found that the so-called
"epileptic personality," characterized by such specific traits as irascibility,
impulsiveness, and egocentricity, certainly does not apply to the non-
deteriorated epileptic. And even should continued research show that they
apply to deteriorated epileptics as a group (even on this point the results
are unclear), the individual variations are as important as the group
trends for at least two reasons. From the point of view of general scientific
laws and principles it is these variations which suggest new leads for the
discovery of "difi'erences that make a difference." From the point of view
of clinical practice, it is the person as an individual who must be treated.
An enlightening study by Levine {1956) also brings out the necessity
of defining carefully the particular population that is being evaluated
among the larger group of persons with the disability. She examined the
productions on the Wechsler test of intelligence and the Rorschach test of
personality of adolescent girls attending a residential school for the deaf.
Although there was an absence of traditional Rorschach signs of emo-
tional disturbance, the personality patterns of the deaf subjects were
characterized by such features as mental and emotional impassiveness,
strong egocentric affectivity, and personal inflexibility. Instead of general-
izing to deafness as a whole, the crucial questions raised point to the fact
that these children, who lost their hearing early in life, acquired language
"fragment by fragment, slowly, painstakingly, in contrived situations,
often out of context, and usually out of rhythm with the growing child's
needs of the moment" (p. 164). The significance of isolation and protec-
tion of the children in many residential schools is also pointed out. The
important end product of such an analysis is that thinking is directed to
the particularization of conditions that predispose toward certain kinds
of functioning (which then, of course, require further investigation as
such) rather than to statements that blanket broad population groupings
simply because they are alike on the surface in some way (see also
Wittkower, 1949, for psychologically diflferentiable subgroups among
those with tuberculosis).
3. Although personality patterns have not been found consistently to
distinguish disability groups as a whole, certain behaviors rather directly
connected with the limitations have. An obvious example is the greater
ease with which the able-bodied get about as compared with the para-
plegic. An example one step removed is the fact that the blind are likely
to be more adept at facial vision (obstacle perception through non visual
cues) than the seeing, and even more so than the deaf (Meyerson, 1953).
But if we look for examples more remote from the direct limitations of
376 Physical Disability — A Psychological Approach
the disability itself, our search yields no highly generalizable facts. Even
such an area as the level of independence from assistance and supervision
by others attained by deaf children as compared with hearing children,
for example, requires a good deal of specification of the findings. At the
very least, the following must be mentioned: (1) no significant retardation
in level of independence has been found in acoustically handicapped
children of preschool ages (Avery, 1948) and (2) as for school-age
children, significant levels of retardation have been found among those
attending residential schools for the deaf (Bradway, 1937; Burchard and
Myklebust, 1942) but not among those attending day schools for the deaf
(Streng and Kirk, 1938).
But in these examples we are dealing with specific behaviors in specific
situations. How these relate to differences in adjustment and personality is
not clear. By the same token, the vastly different behavior of our pioneer
forebears as compared with persons living in our own times by no means
bespeaks ipso facto differences in personality and adjustment. Such dif-
ferences may exist, but they need to be shown through systematic study,
uncontaminated by folklore and biased expectation.
4. Although consistent group trends with respect to personality and
adjustment have not been found, studies of individuals convincingly
indicate that physical disability has a profound affect on the person's life,
as our ample use of personal documents affirms. However, its effect is not
of a direct, consistent kind. Of eight subjects with crippling conditions
described in the literature, one is reported to be immature, nervous, un-
popular, suspicious, and unhappy to the point of serious maladjustment;
five are described as relatively more immature, socially withdrawn, or
emotionally unexpressive than the control subjects, but well within the
normal range; and two are said to be normal, integrated and socially out-
going individuals (Barker et al., 1953:62). In each of these cases,
physique is credited with being a factor in the etiology of the reported
adjustment. However, it is clear that if these eight cases were considered
together as a group, their "average" behavior would not differ appreciably
from that of their normal controls, and the correlation between disable-
ment and level of adjustment would be close to zero.
5. Public, verbalized attitudes toward persons with disabilities are on
the average mildly favorable. An appreciable minority openly express
negative attitudes, though these are more frequently revealed indirectly
(Barker and Wright, 1954). Conditions giving rise to positive as well as
negative attitudes can be seen in some instances primarily as products of
the cultural milieu and in others as residing in the nature of social-
psychological man.
6. The evidence is rather clear that the attitudes of parents toward
their children who have a disability tend to the extreme more often than
An Assessment in the Field of Somatopsychology 377
toward their nondisabled children, centering about the following patterns:
oversolicitude, rejection, pressing for accomplishments beyond the child's
abilities, inconsistent attitudes (Barker and Wright, 1954). Overprotec-
tion appears to occur more frequently than overt rejection. And genuinely
positive attachments of parents to their disabled children are not infre-
quent.
7. What evidence there is on attitudes of persons toward their own dis-
abilities suggests that these attitudes vary widely, have little relation to
the degree of disability in massed data, are related to personality charac-
teristics existing prior to the disability (Barker, et ah, 1953:85), and are
influenced in the direction of acceptance via change in the person's value
system (Dembo, Leviton, Wright, 1956).
Other generalizations could be enumerated here, such as those pertain-
ing to the nature of the ordinary kinds of interaction between persons
with disabilities and those without, which bring about gratification on the
one hand and distress on the other. But the foregoing serves as a highly
generalized picture of the findings of somatopsychological research in
several important areas and leads to a consideration of one of the funda-
mental research principles, namely, the necessity for seeking underlying
factors that will bring lawfulness into the relations between physique and
personality or behavior.
NECESSITY FOR CONSIDERING THE UNDERLYING FACTORS
The failure to find basic personality differences between groups of
persons with specific disabilities and nondisabled subjects undoubtedly
has theoretical implications of such import that, indeed, these "negative"
results are not negative at all. They indicate that persons with physical
deviations are not a homogeneous group psychologically, that physical
disability is a surface (phenotypic) classification. They point to the neces-
sity of getting below the surface, of leaving the nonpsychological realm of
physique and of seeking its underlying psychological significance. This is
one of the main products of the great amount of investigation that has
been carried on, and it is an important product.
The basic situation appears to be that the somatopsychological connec-
tion between physique and behavior is not direct but is mediated by what
have come to be called intervening variables. The following example may
clarify this. It is not the disabled physique as such that makes the person
hide his deformed foot, but his attitudes toward it. These attitudes are the
intervening variables that "logically" connect physique on the one hand
with behavior on the other. Thus, where A's attitudes differ significantly
378 Physical Disability — A Psychological Approach
from B's — let us say that there is shame in the one case and acceptance
in the other — their behavior may be expected to differ also. It is possible,
then, to investigate the specific hypotheses connecting attitudes toward
disability with behavioral consequences, or to interpret existing research
findings in terms of these constructs. But, according to this orientation, if
one were to group together all persons with a deformity of the foot, the
observed behavior must show wide variations, depending on the hetero-
geneity of the intervening variables (attitudes in this case). And since
intervening psychological variables are affected by many conditions,
physique cannot be the factor determining them; hence the lack of one
to one or strong relations between physique and behavior.
This point can be looked at in another way. The variability of psycho-
logical correlates of disability means that the same social situation is not
linked mechanically to personality effects. For example, although a dis-
ability may subject a person to disparagement and discrimination, it does
not mean that this lower status position, even if it occurs with upsetting
frequency, will lead to these or those personality changes. It depends on
what is happening within the person, and these adjustive or maladjustive
changes in turn are aflfected by many variables in addition to those that
inhere in the offending social situation.
In spite of whatever self-destructive tendencies, or even instincts, have
been posited in man, the human being has a tremendous capacity for
reevaluating, for altering his aspirations, for changing the circumstances
of his life, so that he can better cope with the social-psychological situa-
tions surrounding him. These adjustive changes have their source within
the person. But adjustment is a continuing process that goes on at both
loci of the person-environment interaction; changes that have their source
outside the person also occur. Family, friends, and the larger society adapt
to the person, for better or worse, just as the person adapts to them, and
in so doing, these outsiders do change the psychological environment of
the person. This interplay between events within the person and events
from without, ever changing in the efforts of the person to manage more
comfortably, wisely, happily, ever changing through outside influences,
has the inevitable consequence that heterogeneity of effects on the person
is to be expected.
This need not mean that lawfulness does not exist. It would suggest
rather that one cannot predict psychological phenomena, particularly as
they apply to the individual, from simple physical variables. In the words
of Maisel, "neither the occult nor science has yet provided us with any
sure-fire system for sizing up human beings from their physiques"
(7955 .-233).
Much research has already been done in which physique as a surface
characteristic has been taken as the basis for distinguishing the groups
An Assessment In the Field of Somatopsychology 379
under study. And in most instances, as we have seen, the consequences
have been an accumulation of helter-skelter findings. The time has come
when we can look forward to more frequent groupings of subjects accord-
ing to their psychological situations (intervening variables) which the in-
vestigator believes are significant for somatopsychological understanding.
The problem becomes, then, one of determining the nature of the variables
connecting physique and its effects.
The following list of some of the conditions and mechanisms (interven-
ing variables) that have been proposed by various scholars to account for
the psychological effects of physical disabilities is taken from Barker et ah
(1953:92-93): (1) compensation for inferiorities, (2) easy narcissistic
satisfactions deriving from pain and uniqueness, (3) lack of normal play
and expressive actions, (4) easy cathexis to disabled part, (5) unrelated
anxieties transferred to bodily handicap, (6) blame of parents, (7) feeling
of guilt for hostihty toward parents, (8) body image at variance with
reality, (9) efforts to achieve social acceptance, (10) dependent, demand-
ing, apathetic behavior deriving from oversolicitous protective situation,
(11) variable, conflicting behavior in response to variable, inconsistent
attitudes of others, (12) goals beyond achievement possibilities because
of pressure from parents and physical, social, and economic restrictions,
(13) conflict between withdrawal and compensatory tendencies, (14)
acceptance of disability as a punishment for sin, (15) retaliatory behavior
for "unjust" treatment by nature, (16) self-concept, (17) degree of
acceptance of disability, (18) value systems, (19) cultural role of persons
with disabilities, (20) intergroup dynamics.
To this list we could add other somatopsychological variables and such
other mechanisms as covered by the terms "neural," "endocrine," "consti-
tutional," and "psychosomatic." The list is long and varied. In the present
stage of knowledge concerning somatopsychological effects of physical
disability, it is advantageous to have a variety of theories of the sort that
stimulate inquiry.
Some notion of the fruitfulness of intervening variables, we would like
to think, is contained within the present volume. The emphasis here has
been on such concepts as (1) values, (2) status position, (3) the need
for social and personal acceptance, (4) the self -concept, (5) gradients
connecting attributes with the self, (6) spread, (7) goals and standards of
behavior, (8) acceptance of loss through change in values, (9) expecta-
tion discrepancy with its resolution in expectation revision, alteration of
the apparent reahty, and anormalization of the person, (10) the require-
ment of mourning, (11) the principle of positive identification, (12) over-
lapping situations, (13) new situations, (14) motivation, (15) coping
and succumbing aspects of disability, (16) requirements in cause-effect
relations, and others. There is much room for further conceptual clarifica-
380 Physical Disability — A Psychological Approach
tion. Some of the explanatory concepts will prove expendable under the
critical scrutiny of research. Others will take their place. Some will
become more fruitful as the precision of their definitions is increased. In
any case, it seems clear that henceforth, theoretical guidance, comple-
mented by careful methodological checks in the testing program, will be
essential in the effort to reach greater understanding of somatopsycho-
logical problems.
One final point ought to be made explicit. Progress does not wait upon
research effort alone. Existing values, concepts, and factual information
can go far in relieving suffering, in aiding social and psychological
rehabilitation, if only they are applied more genuinely and generally in
the ordinary affairs of life as well as among the many special enterprises
that society as a whole needs to undertake. The present volume may have
contributed to the appreciation of the far-reaching impUcations of the
tetrad of values and concepts singled out by Linck as among the most
important:
( 1 ) the handicapped are a normal part of today's society and do not exist as
a group apart with separate lives. Their needs and rights are the same as those
of any other person; their problems are the problems of all people and should
be considered as a part of the whole society; (2) the handicapped person
should be regarded as a whole person, physically, mentally, socially, and emo-
tionally, rather than within the narrow confines of his handicap; (3) plans
should be made with and for the handicapped person on the basis of abihties,
not disabilities, and of capabilities, not limitations, to most fully develop his
assets; and (4) if these plans are to be reflected in care and treatment services
for the handicapped, teamwork of the highest order is required of professional
personnel in the medical, therapeutic, educational and social and vocational
adjustment fields [and, we should like to stress, teamwork including the patient
and family members] [Linck, 1954:S],
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Index of Names
Abel, T. M., 53, 151, 156, 260, 389
Adler, A., 49, 55, 138, 381, 388
Adler, D. L., 208, 241, 242
Alexander, F., 26, 27, 258, 381
Allan, W. S., 64, 381
Allen, F. H., 55, 381
Allport, G. W., 41, 138, 150, 364, 371,
381
Arluck, E. W., 52, 101, 372, 374, 381
Asch, S. R, 121, 122-123, 168, 174,
260, 381
Ausubel, D. P., 138, 139, 141-142,
181, 186, 381
Avery, C, 376, 381
Baker, L., 3-^, 6, 48, 189, 212, 213,
215, 228, 381
Bard, M., 156, 381
Barker, R. G., 2, 3, 5, 6, 11, 13, 15,
16, 41, 51, 57, 76, 87, 90-91, 92,
93, 95, 97, 98, 100, 119, 124, 154,
179, 182, 192, 229, 261, 314, 318,
322, 333, 346, 356, 357, 372, 373,
374, 376, 377, 379, 381, 382, 390
Barron, M. E., 279, 382
Bavelas, A., 274, 275, 278, 279, 382
Berger, E. M., 43, 134, 382
Berger, S., 150, 382
Bettelheim, B., 150, 382
Bice, H. v., 312, 316, 374, 382, 384
Blair, H., Ill, 390
Blaisdell, F. J., 262, 385
Blake, R. R., 165, 382
Blakeslee, H., 355, 382
Blank, H. R., 109, 111, 115, 140, 141,
154, 256, 382
BoUes, M. M., 24, 53, 135-136, 190,
388
Boorstein, S. W., 83, 382
Bradway, K. P., 376, 382
Braly, K., 120, 387
Brighouse, G., 191, 382
Bronfenbrenner, U., 138, 382
Brown, C, 189, 192, 193, 383
Bruckner, L. S., 142-143, 228, 229,
230-231, 298, 299, 300, 383
Bruner, J. S., 41, 166, 169, 170, 171,
173, 174, 383, 390
Brunschwig, L., 53, 383
Brunswik, E., 369, 370, 373, 383
Bryt, A., 53, 151, 156, 260, 389
Buck, P. S., 66, 110-111, 172-173,
383
Burchard, E. M. L., 376, 383
Cantor, A. J., 356, 358, 383
Cantril, H., 138, 139, 180, 392
Carlson, E. R., 181, 189, 383
Cartwright, D., 263, 332, 383
Castendyck, E., 87, 392
Cattell, E., 63, 123, 124, 383
Chein, I., 219, 383
Chevigny, H., 15, 16, 74, 79-82, 383
Child, I. M., 269, 307, 393
Cholden, L., 109, 383
Citron, A. F., 219, 279, 383
Cleghom, R. A., 3, 394
Cleveland, S. E., 138, 385
Cowen, E. L., 15, 384
Criddle, R., 4, 6, 16, 189, 191, 193-
206, 216-217, 218, 227, 232, 237,
245-246, 384
Crowther, S., 385
Cruickshank, W. M., 38, 99, 291, 302,
374, 384
Crutchfield, R. S., 18, 79, 98, 166,
384, 388
Cutsforth, T. D., 50, 384
Daniels, A. S., 241, 384
Darwin, C, 365
Davis, F., 301, 357, 384
Dembo, T., 20, 21, 25, 53, 59, 63, 79,
395
396
Index of Names
Dembo (Continued):
98, 108, 109, 110, 113, 114, 115,
116-117, 121, 123, 124, 129, 131,
137, 149, 208, 209, 219, 221, 224,
229, 233, 235, 237, 241, 242, 243,
257, 287, 301, 302, 332, 377, 381,
383, 384, 388, 393
Dinkel, R. M., 286, 384
DoUard, J., 88, 384
Donofrio, A. F., 53, 384
Doob, L. W., 88, 384
Dunbar, F., 3, 384
Duncker, K., 256, 384
EUis, A., 257, 384
English, O. S., 3, 393
Estes, S. G., 371, 384
Ewalt, J. R., Ill, 390
Faterson, H. F., 52, 385
Feigl, H., 372, 385
Fenichel, O., 139-140, 385
Feshbach, S., 68-69, 387
Festinger, L., 25, 43, 174, 332, 385,
388
Fey, W. F., 43, 385
Fiedler, F. E., 262, 385
Fielding, B. B., 9, 385
Fisher, S., 138, 385
Fishman, S., 151, 385
Fitzgerald, D. C, 88, 385
Fleming, E. E., 87, 391
Ford H., 15, 385
Foster, I. A., 233, 385
Foxe, A. N., 358, 383
French, J. R. P., Jr., 279, 286, 385
Freud, S., 138, 385
Fromm, E., 43, 385
Fromm-Reichmann, F., 347, 385
Gall, F. J., 365
Garrett, J. F., 6, 161, 346, 350, 385
Gawel, M. L., 393
Gebhard, M. E., 332, 386
Gesell, A., 139, 386
Gilmore, L., 241, 386
Glick, S. J., 348, 386
Goldman, R., 25-35, 75-76, 79, 101,
110, 130-131, 144-148, 153, 158,
160, 161, 164-165, 167, 170, 176,
189, 214-215, 239, 240, 244, 356-
357, 386
Goldstein, K., 142, 386
Gonick, M. R., 2, 3, 6, 11, 13, 16, 41.
51, 76, 100, 124, 154, 179, 182, 192,
Gonick (Continued) :
261, 356, 357, 372, 374, 376, 377,
379, 382
Goodwin, R. B., 108, 386
Grunes, W. F., 142, 386
Haire, M., 142, 386
Hall, C. S., 367, 368-369, 386
Halstead, W. C, 370, 386
Hamilton, K. W., 9, 386
Hanfmann, E., 208, 224, 229, 388
Hanks, J. R., 259, 272-273, 386
Hanks, L. M., Jr., 259, 272-273, 386
Harary, F., 263, 383
Harding, J., 219, 279, 383
narrower, H. R., 359-360, 386
Hartl, E. H., 392
Hathaway, K. B., 157, 386
Hebb, D. O., 264, 386
Heider, F., 18, 48, 53, 86, 94, 121,
256, 257, 258, 260, 262-264, 265,
304, 315, 386
Heider, G. M., 304, 386
Heisler, V. T., 372, 386
Henderson, L. T., 159-160, 298, 386
Hentig. H. von, 51, 76, 255, 259, 260,
261, 386
Herrmann, R., 359-360
Hertzman, M., 165, 393
Hilgard, E. R., 338, 339, 387
Hofstaetter, P. R., 143, 389
Hoist, J. C, 11, 387
Hooton, E. A., 365, 387
Horney, K., 43, 387
Hughes, E. C, 84, 387
Hurlock, E. B., 339, 387
Ichheiser, G., 119, 123, 174, 178, 387
Ilg, F. L., 139, 386
Janis, I. L., 68-69, 112, 356, 360. 387
Johnson, D. L., 372. 373, 387
Johnson, W., 7, 374, 387
Kahn, H., 87, 96, 387
Kammerer, R. C, 53, 303, 387
Katz, D., 120, 387
Keister, H. E., 97, 338, 387
Kelley, H. H., 165-166, 387
Kerby, C. E., 11, 387
Killilea, M.. 14, 63, 217, 249. 299.
303,341, 342, 387
Kirk. S. A.. 376, 392
Kohler, W., 256, 387
Index of Names
397
Koppel, S., 63, 123, 124, 383
Korzybski, A., 7, 165, 388
Kramer, B. M., 41, 381
Krech, D., 18, 98, 166, 388
Kretschmer, E., 367, 388
Ladieu, G., 208, 224, 229, 241, 242,
388
Landis, C, 24, 53, 135-136, 190, 388
Langdon, G., 54, 288, 388
Lauer, E., 53, 151, 156, 260, 389
Lavater, J. C, 365
Laycock, S. R., 288, 295, 296, 388
Lecky, P., 138, 142, 388
Lee, D. D., 7, 388
Levin, H., 308, 309, 391
Levine, E. S., 375, 388
Leviton, G. L., 20, 59, 108, 109, 110,
113, 114, 115, 116-117, 129, 137,
149, 208, 219, 233, 235, 237, 242,
243, 287, 377, 384
Levy, D. M., 10, 388
Levy, J. H., 312, 388
Lewin, G. W., 101, 388
Lewin, K., 25, 40, 47, 98, 100, 138,
181, 332, 381, 388
Lewis, H. B., 165, 393
Linck, L. J., 380, 388
Linduska, N., 20, 43^6, 62, 132-133,
213, 334, 389
Lindzey, G., 41, 367, 368-369, 386,
389
Lippitt, Ronald, 48, 100, 279, 389
Lippitt, Rosemary, 247-248, 268, 389
Lombroso, C, 365, 368, 389
LoweU, E. L., 391
Lowenfeld, B., 38, 159, 298, 312-313,
348, 389
Lowman, C. L., 192
McAndrew, H., 372, 389
Maccoby, E. E., 308, 309, 391
McDermott, E., 392
McDougall, W., 138, 389
Macgregor, F. C, 53, 151, 156, 243,
259, 389
Machover, K., 165, 393
McKenna, Sr. H. V., 143, 389
Maisel, E., 17, 75, 76, 252, 253, 271,
364, 366, 378, 389
Marquis, D. G., 168, 394
Maslow, A. H., 49, 60, 165, 389
Mead, M., 36, 185, 389
Meissner, P. B., 165. 393
Meng, H., 261, 389
Meyer, A., 36, 389
Meyerson, L., 2, 3, 6, 11, 13, 16, 38-
39, 41, 76, 100, 124, 154, 179, 182,
192, 261, 356, 357, 372, 374, 375,
376, 377, 379, 382, 389, 390
Michael, S. T., 115, 393
Miers, E. S., 73, 116, 390
Miller, E. A., 53, 374, 390
Miller, N. E., 88, 384
Mittlemann, B., 49, 389
Monahan, P., 133, 390
Moreno, J. L., 274, 347, 385, 390
Mowrer, O. H., 88, 96, 384, 390
Mullahy, P., 271, 393
Murphy, G., 138, 390
Murphy, L., 60, 390
Mussen, P. H., 57, 119, 229, 390
Myklebust, H. R., 298, 376, 383, 390
Newcomb, T., 36, 390
O'Connor, J. P., 143, 389
Ohnstad, K., 37, 60, 75, 84, 102-103,
119, 128, 189, 236, 238, 239-240,
390
Orgel, S. Z., 243, 390
Orlansky, H., 288, 390
Paterson, D. G., 52, 385
Pearson, G. H. J., 55, 381
Perry, H. S., 393
Piaget, J., 37, 139, 390
Postman, L., 41, 166, 170, 171, 383,
390
Ramsey, G. V., 165, 382
Randall, G. C, 111, 390
Raus, G. M., 291, 347
Ray, M. H., 51, 57, 120, 390
Reiter, L., 369, 383
Rogers, C. R., 60, 140, 148, 347, 390
Rogolsky, S., 41, 389
Rosen, V., 61, 110, 163, 280, 391
Rosenzweig, L., 87, 391
Rosenzweig, S., 87, 91, 97, 391
Rotter, L B., 372, 391
Rusk, H. A., 8, 15, 39, 40, 65, 66, 69,
78, 113, 136, 223, 282, 346, 352,
391
Russell, D. H., 338, 339, 387
Russell, H., 61, 67, 69, 79, 82, 109-
110, 131, 132, 162-164, 165, 167,
398
Index of Names
Russell (Continued):
176-178, 216, 227, 228, 279-280,
281, 391
Rutledge, L., 372, 391
Samuels, M. R., 370, 391
Santayana, G., 165
Sapir, E., 7, 391
Saul, L. J., 134, 391
Schachter, S., 187, 391
Scheerer, M., 252, 256, 391
Schilder, P., 143, 264, 391
Sears, P. S., 25, 332, 388, 391
Sears, R. R., 88, 308, 309, 384, 391
Seidenfeld, M. A., 52, 349, 391
Sheerer, E. T., 43, 134, 391
Sheldon, W. H., 364, 365, 367-369,
391, 392
Shelsky, L, 52, 155, 392
Shere, M. O., 89-90, 303, 306, 309,
392
Sherif, M., 138, 139, 180, 392
Shortley, M. J., 36, 392
Simmons, L. W., 255, 392
Smith, L. E., 39, 301, 392
Snell, E. E., 311, 313, 392
Sommers, V. S., 19, 49, 52, 55, 190,
231,258-259, 288, 303, 392
Spock, B., 298, 392
Springer, N. N., 53, 392
Spurzheim, J. G., 365
Stafford, G. T., 243, 392
Stern, E. M., 87, 392
Stevens, S. S., 391
Stevenson, G. S., 288, 295, 296, 388
Stolz, H. R., 180, 182, 392
Stolz, L. M., 180, 182, 392
Stout, I. W., 54, 288, 388
Stratton, A. J., 354, 392
Streng, A., 376, 392
Strong, E. K., 58, 393
Sullivan, H. S., 138, 393
Sutter, R. C, 283, 304, 393
Tane-Baskin, E., 21, 63, 123, 124, 383,
384
Taylor, E. J., 8, 15, 39, 40, 65, 66, 69,
78, 113, 136, 223, 282, 346, 352,
391
Thompson, C, 271, 393
Thorndike, E. L., 121, 393
Tracht, V. A., 53, 393
Tucker, W. B., 391-392
Tuckman, J., 243, 390
Unterberg, R. P., 15, 384
Vernon, P. E., 371, 381
Verrillo, R. T., 15, 384
Viscardi, H., 82-83, 127, 152, 189,
214, 226-227, 244, 249, 393
Volkart, E. H., 115, 393
Wapner, S., 165, 394
Warfield, F., 21-24, 41-42, 49, 107,
118, 183-185, 215-216, 222, 393
Warrington, W. G., 262, 385
Weinstock, S., 63, 123, 124, 383
Weiss, E., 3, 393
Weissmann, S., 53, 151, 156, 260, 389
Wenar, C, 372, 393
White, G., 291, 316, 349, 393
White, R. K., 208, 209, 221, 393
White, R. W., 83, 393
Whiting, J. W. M., 269, 307, 391, 393
Whorf, B. L., 7, 393
Wilson, A. J., 125, 393
Winkler, H., 124, 263, 393
Witkin, H. A., 165, 393
Wittkower, E. D., 3, 155-156, 375,
394
Wolff, W., 371, 394
Woodworth, R. S., 168, 274, 394
Wright, B. A., 2, 3, 6, 11, 13, 16, 20,
41, 51, 59, 60, 76, 92. 100, 108,
109, 110, 113, 114, 115, 116-117.
124, 129, 137, 149, 154, 179, 182.
192, 208, 209, 219, 221, 233, 235,
237, 242, 243. 261. 287, 333, 346,
356, 357, 372, 373, 374, 376, 377,
379, 382, 384, 393. 394
Wright. H. P., 5. 6. 90-91, 93, 95,
314, 318, 322, 382
Yatsushiro, T., 40, 394
Yerkes, R. M., 252
Zander, A., 279. 394
Index of Subjects
Acceptance of disability:
adjustment and, 134-136
clarification of behavior possibilities
and, 48-49
contrasted with resignation, 108
definition of, 107-108
group belongingness and, 40 ff., 106
illustrated in the life of Noreen
Linduska, 43-46
new psychological situations and,
104
religion and, 299-301
See also Adjustment; "As if"
behavior; Values
Adjustment, 64
definition of emotional maturity,
135
definition of self -acceptance, 134
influence of parents on, 288
oversimplified connection between
disability and inferiority feel-
ings, 53-56
person-environment influences on,
378
physical variations and, 182, 373-
376
See also Acceptance of dis-
ability; "As if" behavior;
Degree of disability; Normal
standards; Values
Adolescence:
acceptance by peers, 187 ff.
conditions for prolonging, 185-186,
193, 194
conformity during, 186
courtship and marriage, 185, 189-
193
criteria for adult status, 185
importance of physique during, 179
ff.
in Russell Griddle's life, 193-206
new psychological situations in, 100
overlapping situations in, 182 ff.
role of peer group during, 186 ff.
Age of occurrence of disability, 153-
157
adjustment and, 154
self-concept and, 155-156
Altering the apparent reality, 73-74,
77
Ambiguous psychological situations:
social acceptance and, 127-128
See also Psychological situa-
tions
Amputation, studies involving, 21, 52,
53, 111, 123, 151, 155, 208 ff.
Animal behavior toward physical devi-
ates, 251-253
Anormalizing the person, 73 ff.
conditions underlying, 76
deification, 75, 76
meaning of, 74
vilification, 77
"As if" behavior, forgetting, and deny-
ing:
adjustment and, 24
as barrier to clarification of be-
havior possibilities, 48—49
body-image and, 151
causes of, 20 ff., 26, 211
consequences of, 23 ff., 46-47, 106,
211, 238
degree of disability and, 53
desire to be understood and, 2 1 1
group belongingness and, 40 ff.. 238
magical thinking in, 22 ff.
role in maintaining normal stand-
ards, 25, 27
Asset values, see Values
Attitudes toward persons with physical
disabilities, 376
animal behavior and, 251-253
399
400
Attitudes (Continued) :
childhood experiences, 265 ff.
direct influence on attitudes, 265-
269
indirect influence on attitudes,
269-271
coping aspects of disability and, 59
flf.
devaluation, 13
expectation discrepancy and, 70 ff.
in primitive societies, 253-256, 272-
273
marriage and, 15
mass media and, 17
perceived cause of disability and,
256 ff.
positive attitudes, 57 ff.
reaction to the different and strange,
262 ff.
socioeconomic factors and, 272 ff.
sources of, 251 ff.
suffering and understanding and, 78
ff.
See also Minority group; Psy-
choanalytic theory; Public
education; "Requirement of
mourning"
Aversions and the coping-succumbing
dimension, 61
Balance theory of sentiments, 262
Behavior overgeneralization, 372
Ben, 318, 321-327, 328, 329, 330-343
Bio-Sciences Information Exchange, 6
Blindness:
adolescence of Russell Criddle,
193-206
age of occurrence and adjustment,
154
anormalizing the person, 74, 76
attitudes toward, 16, 256
behavior possibilities as seen by
nondisabled, 76, 95-96
coping aspects of disability, 60
development of self-concept, 140
difficulty in defining, 11
explanation of, to blind children,
159-160
inconsistency of findings regarding,
371
new psychological situations and,
103
normal standards of behavior and,
37-38
Index of Subjects
Blindness (Continued) :
number of blind, 2
overlapping situations and, 16
overprotection and, 118
studies involving, 11, 15, 19, 38, 49,
52, 55, 58, 141, 190, 191, 231,
258, 288, 303, 372, 375
Body-image, 138, 151
body-person separation, 150-151
processes in development of, 142-
143
reaction to atypical physique and,
264
symbolic meaning of, 141
See also Self-concept
Bringing the outside inside, 282-283
Bully, 243, 246, 249-250
Cancer:
telling patient about, 358-360
Cardiac:
studies involving, 52, 191
Case conferences:
participation of adult client in, 351-
352
participation of parents in, 292-294
Castration theory:
amputation and, 141, 150
attitudes toward disabihty and, 271-
272
blindness and, 141
Cathy, 265-268
Cerebral palsy:
studies involving, 38, 53, 89-90, 99,
283, 301, 303, 309, 314, 374
Childhood experiences and attitudes
toward disability, 265-272
Client's active participation in reha-
bilitation, 345 ff.
basis for, 346
clarifying the situation, 356-357
communication problems, 354 ff.
conditions for imposing decisions,
361
conditions for withholding informa-
tion, 357-360
decision-making and, 345, 357-361
factors hindering, 361-363
illustrations of, 350-354
inviolable rights of chent, 349,
361
principle of comanagement, 345
vocational issues, 347-349,350-351,
352-353
Index of Subjects
Communication problems:
discussing illness with patients, 354-
361
terminology for patients, 354-356
Compensation as indemnity, 49-51
definition of, 49
ethical roots of, 259
negative consequences of, 50-51
positive consequences of, 51
"spread" and, 125-126
theory of Alfred Adler, 49, 55
Conference of Executives of Schools
for the Deaf, 10, 384
Constitutional psychology, 367-369
Containing disability effects, 118-128
Contrast phenomena:
enlarging the scope of values and,
109
group stereotypes and, 18
mourning and, 109
Coping aspects of disability, 59 ff.
attractions and aversions as related
to, 61 ff.
child-rearing practices and, 159-
160, 296
implications for rehabilitation and
education, 64 ff., 247-249, 296,
340, 342
meaning of, 59
position of the person and, 63-64,
248
reconciUng expectations and, 73
respect stemming from, 59, 73
success stories and, 65-66
underlying conditions, 63 ff.
value change and, 60, 173, 247
Cosmetic glove:
study of, 123
usefulness of, 124
Counselor-parent relations:
criteria for positive relationship,
289
interfering counselor attitudes, 291-
296
interfering parental attitudes, 289-
290
technical procedures concerning,
295
topics for discussion, 296-298
Criminal physical types, 365, 368
Cripphng:
studies involving, 24, 51, 53, 55, 57,
58, 83, 88-89, 90, 119, 120,
401
Crippling (Continued) :
124, 135-136, 190, 191, 192,
229, 303, 372
Cross-cultural comparisons, 253-256,
269, 307
Curiosity, 209 ff.
children's, 218-219
conditions influencing reaction to,
209 ff.
desire to be understood, 211
personal context, 210
self-regard, 209
situational context, 210
wish to appear well adjusted, 210
management by the recipient, 21 1 ff.
attacking the offender, 212
excluding the disability from the
situation, 213
minimizing the disability and
preserving the relationship, 216
recommendations, 221 ff.
research, 219-221
staring, 209, 210, 214
Deafness:
age of occurrence and adjustment,
154
anormalizing the person, 74, 76
difficulty in defining, 10
expectation discrepancy, 76-77
new psychological situations and,
103
normal standards of behavior and,
38-39
number of deaf, 2
overprotection and, 304
studies involving, 53, 58, 87-88,
154, 191, 304, 372, 373, 374,
375
Decision-making, 345, 357-361
Dependency:
as a value, 307-311
child-rearing practices and, 307 ff.
developing dependence-independ-
ence balance, 311-315
reaction to help, and, 225
Different and strange, 262 ff.
social rejection and, 262
Disabihty:
degree of, adjustment and, 30, 53-
54
inferiority feelings and, 52
denial of, see "As if" behavior
discussion of, 209 ff.
402
Disability (Continued) :
factors conducive to, 211, 217
parent discussion groups, 3 12
recommendations, 221-223
duration of, inferiority feelings and,
52
exaggeration of, 64
See also Spread of evaluation
Disability effects, containing, 118-128
Educational materials:
for parents, 298-299
for patients, 355-356
Endocrinology and personality, 366-
367
Epilepsy:
new psychological situations in,
100-101
studies involving, 52, 372, 375
Ethics and disability, 27, 29, 106, 133,
257, 259, 261
See also Punishment
Evil and disability, 26, 133, 257, 259,
260, 261
Expectation discrepancy, 70 fE.
conditions underlying, 71-72
definition of, 70
reconciling the, 73 flf.
resulting emotions, 70-71
Expectation revision, 73, 77
Expectations:
in the adjustment process, 171, 172,
173
in determining reaUty, 176-178
in interpersonal relations, 166 ff.,
174 flf.
influencing perception, 96, 169
role of self-concept in, 167 flf.
strength of, 169 flf.
Expressive movements, 370-371
Facial disfigurement:
studies involving, 53, 151, 156, 208,
260
Fear as reaction to disability, 263, 264
Frustration, 86 flf,
barriers to overcoming, 99
common sense notions concerning
disability and, 87, 89-99
coping with, 91-92, 94, 97
definition of, 86
frequency of, 88-89
idolizing normal standards and, 99
level of aspiration and, 92, 94
Index of Subjects
Frustration (Continued) :
negative consequences of, 97-98
optimal childhood experiences with,
97
persistence of incorrect notions con-
cerning disability and, 94-96
positive consequences of, 97-98,
140
role in development of self-concept,
140
studies of, 87 ff.
training in handling, 97
Genetic reductionism:
principle of, 251
Goals:
establishment of, in rehabilitation
settings, 38-40, 334
See also Normal standards
Group belongingness and identifica-
tion:
acceptance of disabiUty and, 40 ff.
"as if" behavior and, 40 ff.
in the life of Frances Warfield, 41-
42
Group discussion, 283-286
Group stereotypes, 17-18
assimilation phenomenon, 18
contrast phenomenon, 18
spread and, 126
Guilt feelings:
cause of disability and, 258, 270
compensation and, 49-50
inferiority feehngs and, 26
overprotection and, 315, 316
parental, 297, 315
rejection of disabiUty and, 41
Health as a value, 257
ethics and, 257
Help, 223 ff.
as a social relationship, 224
as an expediting act, 224—225
evaluation of, 223-225
management by the recipient, 225
ff.
recommendations, 229 ff.
training in handling, 274 ff.
Hope versus stark reality, 301-303,
360
Humoral theory of personality, 366
Independence:
as a value, 307-311
Index of Subiec+s
Independence {Continued):
child-rearing practices and, 307 flf.
developing dependence-independ-
ence balance, 311-315
reaction to help and, 224, 225, 304
Inferiority feelings:
Adlerian theory, 49, 55
consequences of, 106, 170
guilt and, 26
hypotheses supporting, 172
inferior status position, 13 ff.
influence on social perception, 170
intervening variables and, 53-54
normal standards of behavior and,
25 ff.
of persons with disabilities com-
pared with nondisabled, 52-56
opinions concerning, 51
research findings, 51-52
role in overlapping situations, 185
sources of, 106, 172
See also "As if" behavior;
Compensation as indemnity
Institute on Psychology and Rehabili-
tation, 60
Institutionalization:
issues involved in, 349-350
Integration of children in schools, 247,
264
Interpersonal relations:
as a problem in perception, 165 fif.
curiosity, 209 ff.
discussion of the disabihty, 211,
217, 221
expectancy strength and, 169 ff.
grievances and gratifications in, 208
ff.
help, 223 ff.
mutual understanding in, 174 ff.
perception of intentions in other
people, 163, 168, 174
ridicule, 242 ff.
role of expectations in, 166
self-perception and, 167 ff.
staring, 209, 210, 214
sympathy, 233 ff.
training in social skills, 275 ff.
Intervening variables:
list of, 379
need for, 54, 373, 377-379
Karen, 13-14, 62, 217, 249, 299, 303,
341, 342
403
Level of aspiration:
as protective mechanism, 25, 92,
337
studies of, 372
See also Success and failure
Libraries of disability materials, 298
Lila, 95, 318, 328-330, 330-343
Love:
meaning of, 288
overprotection and, 315, 316
Marriage, 84
as criterion for adult status, 180,
185
of persons with physical disabilities,
191-192
Member employee programs, 282
Minority group, 14—20
differences, 18-19
overlapping situations, 16
principle of vigilance, 41
"requirement of mourning," 15
stereotypes, 17-18
underprivileged status, 14—15
Motivation, 318 ff.
expectation and, 173
immediate versus long-term goals,
334
improving motivation, 330-344
attitudes involved, 339-340, 342-
343
background factors, 340-342
embedding the task, 330-331,
335
extraneous incentives, 339
feelings of motivator, 343
success versus failure, 331-338
level of aspiration and, 337
normal standards and, 27 ff., 36
participating in establishing goals,
336-337
rewards and punishments, 339
shame and, 29
social facilitation, 340
subgoals, 335
See also Client's active partici-
pation in rehabilitation; Cop-
ing aspects of disability
Mourning:
all-inclusive suffering, 110-111
conditions underlying, 109-112
disability as personal loss, 109-110
disability as social loss, 110
dominance of loss aspects, 109
404
Mourning (Continued):
enlarging the scope of values dur-
ing, 108, 112
healing function of, 114-115
other reactions to loss, 111-112
overcoming, 112-115
role of contrast phenomena, 109
self-concept and, 109
societal role in, 115
See also "Requirement of
mourning"
Multiple sclerosis:
studies involving, 359
National Health Education Com-
mittee, 2, 390
New Fountains, 241
Normal standards:
adjustment and, 36, 37
as motivating factor, 27 ff.
consequences of maintaining, 25 flf.,
337, 338
idoHzation of, 24 ff., 99, 106
in the life of Raymond Goldman,
27-35
moral value of, 27, 29
neurosis and, 35-36
reasons for maintaining, 24 ff., 37-
38
rehabilitation practices and, 38—40
sex appropriateness and, 179-180
sex differences and, 36
shame and, 27
social participation and acceptance,
238-242
Overlapping situations :
in adolescence, 182 ff.
in minority groups, 16
involving disability, 16, 183, 184
Overprotection, 303-317
amount of, and children with dis-
abilities, 303
as a judgment, 306-307
attitude toward, on part of person
with disability, 304
behavior of overprotected child,
306, 309
behavior of overprotective parent,
305-306
definition of, 305
reevaluation of, 311
Index of Subjects
Overprotection (Continued) :
spread and, 1 1 8
underlying attitudes, 315
See also Independence
Paraplegia:
studies involving, 150
Parents :
attitudes of, 258, 376-377
developing dependence-independ-
ence balance, 311-315
discussion groups for, 312
hope versus stark reality, 301
influence on child adjustment, 288
motivating children, 318 ff.
overprotection on part of, 118,
303-317, 377
reading material for, 298, 299
topics to be discussed with, 296-298
See also Counselor-parent re-
lations; Overprotection
Patient Publication, 355
Perception:
perceiving and fitting facts, 252-253
See also Phenomenal causality
Persons with physical disabilities:
attitudes toward disability on part
of, 9, 106, 377
jokes about, 13
numbers of, 2
satisfactions in the lives of, 5-6
See also Adjustment; Attitudes
toward persons with physical
disabilities
Phenomenal causality:
blame and, 258
evil as cause, 26
person-environment attribution, 86
requiredness in cause-effect rela-
tions, 133, 256 ff.
self-concept and, 140-141
Phrenology, 365
Physical criteria:
of sex appropriateness, 179-180
relation between behavior, per-
sonality, and, 11, 364 ff., 373-
377
See also Intervening variables
Physical disability:
awakening interest in, 1
generality of psychological prob-
lems, 3, 78
Index of Subjects
Physical disability (Continued):
need for psychological study of, 1-2
numbers of persons with, 2
Physically disabled:
connotations of term, 7-8, 265
See also Persons with physical
disabilities
Physiognomy, 364-365, 369-370
Physique as prime mover, 96, 118,
123, 126
compensation as indemnity, 125-
126
See also Spread of evaluation
Pity, 233
training in handling, 274 ff.
Poliomyelitis:
studies involving, 9, 52, 53, 301,
357
Positive identification:
principle of, 153, 291
Primitive societies:
attitudes toward atypicaUty in, 253-
256
commonality and diversity, 255-256
dependence-independence and, 307
Psychoanalytic theory:
childhood experiences and attitudes
toward disability, 269, 271
dependency and, 309-310
influence of parents and, 288
self-concept in, 139, 141
Psychological Abstracts, 6
Psychological situations, new, 99 ff.
acceptance of disability and, 104
clarification of behavior possibiUties
and, 101
dangerous versus nondangerous,
103-104
definition of, 100
disability connected, 100-101
in diagnostic and treatment situa-
tions, 356-357
reactions to, 100-104
Public education:
criterion for evaluating, 67
need for, 247, 264
research study on, 68-69
role playing and, 247
Punishment as cause of disability,
257-258, 259, 261
Real-life situation:
with other novices, 281-282
405
Real-life situation (Continued) :
with person who "knows," 279-281
Realization amid interpersonal accept-
ance:
principle of, 158
Rehabilitation Literature, 6
Rehabilitation practices:
activities of daily living, 114
coping aspects of disability and, 60-
61, 64 ff.
developing dependence-independ-
ence balance, 311-315
hope versus stark reaUty, 301-303,
360
importance of parental role, 288 ff.
motivation problems, 318 ff.
normal standards of behavior, 38-
40
repetitive therapy, 343
training in social skills, 274 ff.
work of mourning, 114-115
See also Case conferences;
Client's active participation
in rehabilitation; Counselor-
parent relations
Religion:
acceptance of disability and, 299-
301
blind in religious beliefs, 76, 259
disability in, 259, 260
Requiredness in cause-effect relations,
256 ff.
as seen in emotional disability,
256-257
cause of disability and, 258-260,
270
effects of disabiUty and, 260
meaning of, 256
"Requirement of mourning," 15
emphasis on succumbing aspect of
difficulties, 64
expectation discrepancy and, 71, 72,
74
meaning of, 242-243
nicknames and, 243
ridicule and, 243, 246
Ridicule, 242 ff.
age and, 243
circumstances that sanction, 242
management by the recipient, 244—
246
nicknames and, 243
406
Ridicule (Continued) :
recommendations, 246-250
role in changing self -concept, 147-
148
role of bully, 243, 246
underlying conditions, 242-243, 246
Role playing:
advantage of, 278
developing adjustive attitudes, 247
developing social skills, 274 ff.
in public education, 247
procedures in, 274-278
Salutary status, 57 ff.
contradiction in status, 84—85
See also Coping aspects of dis-
ability; Expectation discrep-
ancy; Suffering and under-
standing
School:
child with disability entering, 145-
146, 244, 249
education regarding disability in,
247-249
integration of children in, 247, 264
Secondary gains of disability, 173
Self-acceptance and acceptance of
others, 43
Self-concept, 138 ff.
adolescent, 179 ff.
age of occurrence of disability and,
155-156
body-person separation, 150-151
conclusions for child-rearing prac-
tices, 158-161
development of, 139-144, 194
difficulty in changing, 148, 156
expectations and, 167 ff.
importance of, 138
integration and self-evaluation,
144-148
and identity of self, 154
in the life of Raymond Goldman,
144-148, 158
interpersonal relations and, 162 ff.,
209. 224, 232, 233
meaning of, 138-139
physique and, 118
role in determining reality, 176-178
role of mourning in preserving, 109
role of ridicule in affecting, 147-
148
Index of Subjects
Self-concept (Continued) :
self-connection gradient, 149-151
during adolescence, 179, 181
factors determining position on,
149-151
status-value gradient, 151-153
during adolescence, 179
factors determining position on,
151-153
sudden changes in, 153
Semantics and word usage:
disability versus handicap, 8-10
importance of, in somatopsy-
chology, 8
spread of evaluation influenced by,
8, 126
terminology for patients, 354-356
Shame and guilt, 26 ff.
as motivating factors, 29-30
compensation and, 49-51
concealment and, 33
Social acceptance, 237 ff.
accommodating behavior, 239-242
deviation and, 187-188
participation and, 36-37, 239-242
"treat me like anyone else," 238-
239, 240-241
See also Marriage
Social psychology:
significance of for individual be-
havior, 3
Social skills:
training in, 274 ff.
Socioeconomic factors, 272 ff.
Somatopsychology, 1-3
and social psychology, 3
bibliographic sources and reviews, 6
general results of, 373-377
inconsistency of findings in, 371-
373
Somatotype theory, 367-369
Spread of evaluation, 118 ff.
central and peripheral characteris-
tics in, 121, 123-124
comparative values and, 71, 131-
133
difficulties in restricting, 119
examples of, 118-120
expectation discrepancy and, 71
explanation of, 120-124, 131, 144.
149 ff.. 152, 260
halo effect and, 121
Index of Subiects
407
Spread of evaluation (Continued):
nationality and, 120
outstanding success and, 82-83
parental understanding and, 297
social difficulties resulting from,
126-128, 242, 264
theoretical misconceptions resulting
from, 125-126
visible characteristics and, 123
word usage and, 8
Status:
contradiction in, 84-85
See also Minority group; Salu-
tary status
Stories:
discussion of, for training, 286-287
Stuttering, 374
Subject overgeneralization, 372
Subordinating physique, 115-117
See also Values
Success and failure:
adjustment and outstanding success,
83, 84
conditions underlying, 25, 332
consequences of, 331-332, 337
evaluating rehabiUtation settings in
terms of, 338
frequency of, 90-91, 333
indications of, 332
interferences in normal functioning
of, 337
level of aspiration and, 92, 332, 337
motivation and, 331-338
normal standards and, 26 ff., 36, 37
notable persons with disabilities, 83
preparation for failure, 338
protective governing apparatus in,
91-92, 94, 337
Success stories, 65-66, 83, 84
Succumbing aspects of disability, 59 ff.
meaning of, 59
See also Coping aspects of dis-
ability
Suffering and understanding, 78 ff.,
261
salutary status and, 78
Sympathy, 233 ff.
insincere, 234, 236
nature of, 234 ff.
congruence of feelings, 234-235
readiness to help, 236-237
understanding. 235-236
pity, 233
Sympathy (Continued):
reasons for rejecting, 233 ff.
training in handling, 274 ff.
Terminology for patients, 354-356
"Treat me like anyone else," 238-239
Tuberculosis :
studies involving, 52, 155, 156, 354,
374
Understanding the Disabled:
instruction booklet, 247, 268-269
semantic implications, 126
Values:
asset and comparative, 128-133
definition of, 129
importance in adjustment to dis-
ability, 130-132
in Raymond Goldman's adjust-
ment, 33, 35
spread and, 71, 131-133
when indicated, 137
containing disability effects and,
118-128
and normal standards of be-
havior, 37
coping aspects of disability and,
60
difficulties in, 119
in Raymond Goldman's adjust-
ment, 33
versus compensation as indem-
nity, 126
when indicated, 137
enlarging the scope of, 10&-115
activities of daily living and, 1 14
conditions for, 113-114, 137
coping aspects of disability and
value change, 60
definition of, 108
in Raymond Goldman's adjust-
ment, 33
role of contrast phenomena in,
109
role of satiation in, 1 14
Harold RusseH and value change,
163-165
interrelations among, 136
motivational implications and value
change, 173
perception and, 25
408
Values (Continued):
Raymond Goldman and value
change, 32-35
recommendations concerning value
change, 136-137
subordinating physique, 115-117,
137
and the problem of ability, 116-
117
and the problem of appearance,
116
in Raymond Goldman's adjust-
ment, 33
Index of Subjects
Values (Continued):
See also Coping aspects of dis-
bility; Spread of evaluation;
Succumbing aspects of dis-
ability
Vigilance:
principle of, 41
Vocational guidance:
client participation in, 347-349,
350-351, 352-353
Wally, 5, 6, 92-93, 318-321, 330-343
, I
75 76 16 13
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